Cayman residents suffering from mental disorders may not get the care they need due to a lack of insurance coverage and accessibility to care, health officials say.
“We realize that obviously the systems that are in place are not sufficient for the numbers. There is still a lot more to be done,” Mental Health Commission chairman Dr. Marc Lockhart said in an interview last month.
“The biggest issue is accessibility as opposed to it being pure costs,” he said.
Free mental health care at the Health Services Authority is limited, with long wait times, especially for young people, he said.
“There are not enough therapists there. The HSA only has one psychologist that focuses on children, and they have one part-time psychiatrist that addresses issues with children.”
For adults seeking mental health services, the Employee Assistance Program is available, but it is also crammed with patients. “The numbers highlight that we don’t have enough resources. We realize that EAP is full; it is just not enough,” said Dr. Lockhart.
In an effort to help fill the gaps in the mental health system, a new outpatient facility, Behavioral Health Associates Cayman, recently opened. The facility offers local access to two psychiatrists, two psychologists – including a child psychologist – and a life coach.
Dr. Lockhart believes this facility can help take some of the load off the other organizations that offer mental health care and could also offset the high costs of overseas care.
“The advantage of us here is that we have all the resources here to start the process,” Dr. Lockhart said. “We are better able because of our set up to do an assessment, start a treatment plan, make medical interventions, provide counseling and guidance all in one facility.”
He pointed out, however, that the outpatient facility does not cater to chronic mentally ill patients who need residential care.
“Even with what we’re providing here, there are still limitations … there are many times when a young person may require placement outside of their home in a residential type facility, and we don’t have that on island.”
Most insurance companies provide the bare minimum in coverage for mental health treatment and care, particularly private insurers, according to Mental Health Commission member Dr. Taylor Burrowes Nixon.
“People who have private insurance don’t get coverage for mental illness. In general, it is not seen as something that should be included in benefits because of the range in severity,” said Dr. Burrowes.
She said if insurers took on a more preventive approach, such as including counseling and psychotherapy, in addition to mental health treatment in their plans, they might help prevent patients from developing severe mental illnesses, which would in turn save them more money in the long run.
Jeanette Verhoeven, a broker at Aon Risk Solutions Health and Life Insurance, said outpatient mental health coverage is a mixed bag among plans, ranging from no outpatient visits, minimal mental health and nervous disorder coverage for prescriptions, to $500 to $1,000 coverage per year or more.
Mental health disorders “do not receive the major emphasis and priority that the medical benefits have,” she said. “With health insurance premiums being so high already, we do not usually see employers, or even the general public clamoring to see those benefits enhanced, unless their lives personally become affected by such events, then the coverage or lack of coverage takes on more importance.”
Dr. Burrowes said the basic insurance plans often leave many patients who are on a limited budget in a tough spot.
“I know people who are on welfare that have had to pay out of pocket, struggling to get that money together. This is something that they need every month. It puts them in a state of constant duress that exacerbates the mental illness.”
Dr. Burrowes said in most cases, private insurers will offer her clients at the Wellness Center a lifetime cap, which is usually inadequate. “That could be decent [coverage] for someone who is coming in who just needs counseling, but for someone who has a diagnosed mental illness, that is going to be difficult,” she said.
“For major depression, I’ve seen patients for years once a week, 50 sessions per year is what they need – they are constantly suicidal, and holding on by a thread. The only thing that helps is that connection and consistency.”
Dr. Burrowes said the lifetime cap, which works out to roughly $1,000 per year, and with her rate of $150 per hour, the insurer would cover fewer than 10 sessions per year. For chronic mental health sufferers needing inpatient treatment, the basic insurance plan covers about 45 days of residential care.
“I know from experience, since we don’t have a residential facility, a stint at a residential treatment overseas for 45 days would cost $25,000,” Dr. Burrowes said.
At the moment, the only inpatient service available locally is an eight-bed facility at the Cayman Islands Hospital.
Minister of Health Osbourne Bodden said in an email in June that more mental health resources would be needed “to deal with the growing number of children and adults who need this help.
“It’s unfortunate at this time that we still have to have our people receiving long-term care overseas, and my goal is to bring them all home as soon as possible. We must also remove them from our streets and make families, residents and visitors feel safer going forward,” said Minister Bodden.
Dr. Burrowes said reform to the health insurance law would be needed to help alleviate costs to patients. “The insurance reform is necessary – we need to get it to be client centered – it is shortsighted the way that they are providing these services,” she said.
According to Health Insurance Regulations (2013 Revision), a standard health insurance contract covers $25,000 per lifetime per patient for inpatient mental expenses.
Mrs. Verhoeven said “a few comprehensive-type health plans cover more than [the standard plan], but it was indeed legislation…that added those inpatient benefits coverage to all plans.”