By Spencer Hunt
and Debra Jasper
Enquirer Columbus Bureau

Member's of Cincinnati's Junior League are active in lobbying for solutions to mental health issues. Julie Webster (from left), June Landrum-Springer, Barbara Fitch and group President Reba St. Clair stand in the Ohio Senate chamber. (Michael E. Keating photo)

Where is the line between sickness and insanity? The answer can hinge on a single chemical in your brain.

People who don't have enough dopamine in their brains suffer from Parkinson's disease. People who have too much suffer from schizophrenia.

For families, that distinction also can be the difference between keeping and losing their homes, their jobs, their life savings.

Most health insurance covers physical illnesses such as Parkinson's. But policies typically cover no more than 20 or 30 days of treatment a year for schizophrenia or other mental illnesses. Doctors and others say that's unfair - and emotionally and financially devastating to families with mentally ill children.

"Would you have a policy where you insure the left leg but not the right leg?" asks Dr. S.R. Thorward, a psychiatrist at Twin Valley Behavioral Health Care in Columbus. "That's the situation in Ohio, where you insure one system in the brain but not another."

A few elected officials are pressing for reforms and offering solutions. But insurance groups, businesses and other officials say government can't afford to pay the enormous costs of more coverage. Small businesses, they say, can't afford any new insurance rate hikes, even small ones.

"One of the big fantasies is that every employer would be able to buy everything they'd want for their health plans," says Kirby Nielsen, a board member on the Ohio Association of Health Underwriters. "That's not the real world. Too many options get too expensive."

With insurance so limited, however, parents often struggle to pay for costly treatment for their mentally ill children. Many end up trapped in a state system so convoluted they never get help.

Some desperate parents give up custody of their children to the government, so it can pay for care. When they sign their kids over, they lose control over where their children are sent, what kind of treatment they get and how long they will stay away.

Advocates and doctors like Dr. Mike Sorter, director of child psychiatry for Cincinnati Children's Hospital Medical Center, say it's no wonder that parents are outraged.

"If you asked a politician, 'What are you going to do about a drug benefit for seniors?' they couldn't get away with saying, 'I don't know,' " Sorter says. "They can get away with that answer when you ask what they are going to do to help the mentally ill."

Make insurance pay

Ohio state Rep. Lynn Olman, R-Maumee, has tried for eight years to pass a bill that would make insurance companies fully cover mental health care. He points out that the state of Ohio covers its own government employees but won't force private companies to do the same.

"We're real good at giving ourselves benefits, but not our constituents," he says.

Olman is trying again this year with a bill that would force insurance companies that sell health plans to small and medium employers to cover treatment for six major mental illnesses, including schizophrenia, bipolar disorder and major depression. All are linked to chemical imbalances in the brain that can be treated with therapy and drugs.

While the proposal would increase insurance company costs, Olman says most Ohioans would barely notice it.

"It's about a 1 percent additional cost to your premium to add that benefit," Olman says. "If you have a $100 premium your increase would be $1 a month."

Olman cites studies of states that passed similar laws. An Anthem Blue-Cross Blue Shield study of Vermont's law found people paid an average of 19 cents more per month.

Olman managed to get the plan passed in the House in February but faces formidable opposition in the Senate.

"We don't believe the government needs to say what coverage needs to be provided," says Kelly McGivern, president of the Ohio Association of Health Plans, which represents health insurers that cover 6 million Ohioans.

Others insist that current mental health coverage is adequate for most people. Nielsen, who suffers from chronic depression, says his plan pays for all his medications and that he's never gone past the annual, 20-visit limit on counseling sessions. "Most policies do have adequate benefits to cover most people," he says.

Gov. Bob Taft says more needs to be done for the mentally ill, but he's called for a moratorium on any new insurance mandates. "The more services required to be covered, the more expensive the overall policy," he says. "It's a huge issue with small businesses."

Leave custody alone

State Sen. John Carey, R-Wellston, wants to force counties to pay for treatment of mentally ill children - without taking custody away from parents. Instead, child welfare officials would have to sign agreements that let parents keep custody and have a say in the care their children get at the institutions where they're placed.

A court would review the agreements every six months. Parents would be required to help pay for their children's care using a formula that divorce courts use to calculate how much a parent should pay for child support. Carey says the voluntary agreements could be written to still allow counties to tap into federal funds reserved for children in the government's care.

"We just don't think it's right that parents should give up custody to get treatment for their kids," Carey says. "I think this is a bill that's hard to be against."

County officials say they don't want to force parents to give up their children, but they believe it's the only way they can tap into federal money to help pay treatment costs that can run as high as $1,000 a day. They argue that Carey's bill would weaken their control over how that money is spent, increase demand for services and force them to spend even more than they do now.

"This has the potential to break the bank of child welfare agencies across the state," says Gayle Channing Tenenbaum, legislative director for the Public Children Services Association of Ohio, a group that lobbies on child welfare officials' behalf.

Tenenbaum says child welfare agencies increasingly shoulder more of children's mental health costs with their own local tax dollars. She says the state should find more money to pay for kids' care or the system will fail.

"We're here for families who've been abused and neglected," Tenenbaum says. "The group of children we're talking about with custody relinquishment are not abused, not neglected and their parents are totally involved in their lives."

The bill has yet to have its first hearing in a Senate committee, but Carey remains optimistic.

"I think we've gone pretty far with this," Carey says.

Paying attention

Despite differing philosophies over what's to be done, nearly everyone agrees that families are in a dismal place.

"Families are totally consumed by this," says Barbara Fitch, a Junior League of Cincinnati member who is working to help parents with mentally ill children. "Parents are putting themselves in total hock or their other children are suffering. It's very disturbing."

Groups like the Junior League are hopeful that changes may be coming. Reba St. Clair, president of the local group, says its members have worked hard to persuade lawmakers and local officials to help more families with mentally ill children. Their program, Mind Peace, which includes officials from Children's Hospital, also has brought local child welfare agencies, mental health boards and other officials to the same table to discuss solutions.

St. Clair says the Junior League hasn't yet hasn't taken a stand on any one proposed reform, but it's clear that families desperately need more help.

"By not doing anything to fix the system, we're doing nothing," St. Clair says. "And doing nothing is wrong."