As C.A. MacConnell deals with the numerous challenges involved in coping with bipolar disorder, many people would consider her plight unfortunate.
MacConnell's routine includes daily doses of four strong psychotropic medications to alleviate her symptoms, as well as regular therapy sessions to help her understand the chemical imbalances in her brain that — if left unchecked — can spark an emotionally chaotic life of erratic behavior filled with euphoric highs and debilitating lows.
MacConnell, though, says she is lucky in at least one sense. Without any health insurance coverage, she still can partially rely on a support system of family and friends who help her afford her expensive prescription drug regimen. One prescription alone costs $425 per month, and MacConnell faces a veritable mountain of medical debt. But at least she has her medicine.
Many Ohioans who also have bipolar disorder or other mental illnesses that require prescription drugs cannot afford them. They, like MacConnell, are employed and earn too much to qualify for Medicaid benefits but lack enough money to buy insurance. As a result, their conditions go untreated, and the disorders continue to wreak havoc in their lives.
Falling in the Gap
"There's a lot of people like me who are ashamed because we constantly have to beg and borrow to stay ahead, but there are other people who have it worse," says MacConnell, 32, of Clifton.
"I'm in a fortunate position because I have a lot of outside support, and I'm well enough to go out and speak about these things. A lot of people aren't in this situation. They have no help or support."
To juggle her bills while trying to keep healthy, MacConnell holds down about three jobs at any given time, including one as a part-time yoga instructor and another as a freelance writer. She has recently written about her disorder for CityBeat (see "Free From My Psychotic Fall," issue of Jan. 17).
"One problem with bipolar disorder is environment plays a big part of recovery," she says. "I have to do things at my place of employment to help keep my illness in check. It's very difficult to manage without some flexibility."
MacConnell went to the Ohio Statehouse in Columbus last week to attend a budget hearing held by the House Finance Subcommittee on Human Services. She is one of many individuals and mental health organizations lobbying state lawmakers to get money put in the 2007-08 Ohio budget for working people who fall in the funding gap: They aren't eligible for Medicaid and don't have insurance, so they cannot get medications or visit their doctors regularly.
MacConnell appeared in conjunction with efforts to expand Medicaid coverage being led by the Ohio chapter of the National Alliance on Mental Illness (NAMI). The organization states that about 500,000 of Ohio's more than 11.4 million residents have a severe mental illness. Nationally, one in five Americans will suffer some type of mental disorder in any given year.
Other statistics about mental illness are just as alarming.
In the United States, mental illnesses account for more than 15 percent of the overall burden of disease from all causes, slightly more than that of cancer, according to NAMI research. Indirect costs for untreated mental illness such as lost productivity were estimated at $79 billion nationwide; in Ohio, the indirect costs were estimated at more than $3.5 billion.
About 19 percent of inmates in Ohio's jails suffer from chronic mental illness, roughly five times higher than rates of mental illness among the general population, said Betsy Johnson, NAMI-Ohio's associate executive director. That figure is important because each adult inmate costs the state on average $20,100 each year to incarcerate, and it costs the state more than $84,000 each year per child for juvenile detention, she adds.
Studies indicate those costs could be significantly reduced through expanding treatment options that would prevent some people from being jailed in the first place and possibly prevent others from returning to the corrections system.
Investing in Treatment
Several states — including California, Florida, New Hampshire and Oklahoma — are experimenting with changes to their Medicaid systems, usually involving a switch away from the "fee for service" model into a more integrated approach.
In California, for example, a bill passed in 1999 allowed unrestricted access to medications and expanded the types of support services available. For the state's initial investment of $10 million into the program, it saved the state $20 million in reduced hospitalization and incarceration costs during the first year.
NAMI is encouraging similar reforms for Ohio.
Gov. Ted Strickland's proposed two-year state budget totals $52.9 billion. Of that amount, $23.9 billion is allocated for health and human services. Still, mental health advocates say that's not enough to close the treatment gap, which drives up costs elsewhere in the spending plan, such as the $3.7 billion proposed for corrections and public protection.
State lawmakers are debating changes to Strickland's budget and must approve a plan by midnight June 30.
Meanwhile, MacConnell continues her struggle to make ends meet while learning to live with her manic depression.
"I've seen people with mental illness die, and they die not because of their illness being too wicked, they die because they don't have any treatment or support," she says.
Besides the moral argument for making medication more readily available for those who need it, MacConnell believes it's in society's best interests.
"It would benefit the government to have more assistance in place," she says. "Right now the system discourages people from working. I should be able to have an illness and live, work and be a productive citizen without having this problem weighing me down all the time."
For more information on the National Alliance on Mental Illness, call 614-224-2700 or visit www.namiohio.org.