Wrong to remove critical line of defense in America’s mental health crisis

When President Obama convened the National Conference on Mental Health at the White House last summer, he spoke of the importance of bringing mental illness “out of the shadows.”

“You’re not alone,” the president told the gathering. “You’re surrounded by people who care about you and who will support you on the journey to get well.”

Unfortunately, for millions, that journey is about to get a lot harder.

If the Centers for Medicare and Medicaid Services (CMS) gets its way, seniors and persons with disabilities who rely on medication to treat depression will lose critical access beginning in 2015. According to a proposed rule issued by CMS last month, antidepressants will be removed as a “protected class” within the Medicare prescription drug program, leaving only one-third of antidepressant medications available for seniors and those with disabilities, barring any intervention from higher governmental powers. For millions of Americans, the effects of this otherwise obscure policy change will be devastating.

Consider the following: More than 35 million Americans are enrolled in Medicare Part D, which has arguably been one of the most successful (and well received) federal programs in history. Depression, the nation’s most common mental health condition, is especially prevalent among seniors and can lead to significant personal, economic, and societal consequences if left untreated.

Put simply, taking away a key line of defense in the war on depression symptoms – a cornerstone of ensuring patients have much-needed access to treatment options— is bad policy. The administration should set it aside immediately and reinforce its commitment to meaningful action.

Regardless of viewpoint, the side effects of a policy change designed to save a tiny fraction ($144 million) of Part D’s overall budget, will only increase the frequency of related hospitalizations, emergency room (ER) visits, and other unintended and otherwise avoidable consequences. Given that the total direct and indirect costs of depression in the United States exceed $83 billion annually, if we can’t treat it effectively through a highly cost effective program like Medicare Part D, we’re failing millions of Americans who have few other options.

Equally important, treatment of this condition is not a one-size-fits-all endeavor. Similar to cancer or HIV/AIDS, people with depression are often faced with unsuccessful treatment regimens that only increase relapse rates and lessen chances of remission.

The brain is a very complex organ and there is nothing typical about treating mood disorders. It is common for people living with a mental health condition to work closely with their physician, trying several different medications before they find the one that provides successful outcomes. People with mental health conditions often present with other physical health conditions. The interactions between antidepressants and medications to treat other physical conditions mandate the utmost flexibility for physicians to prescribe the most appropriate, quality mental health treatment.

In addition to access, appropriate timing of treatment is critical for people with mental health conditions. By removing antidepressants from protected class status, CMS is suggesting that antidepressants do not meet the criteria that these medications need to be prescribed within seven days to avoid hospitalization. CMS is asserting that people living with mental health conditions, even those with suicidal symptoms, are not at high risk for hospitalization – a conjecture that is reckless and potentially life-threatening.

Restricting access to mental health treatments is senseless and irresponsible. Against the backdrop of a huge unmet medical need for effective depression treatments overall, limiting options for patients and doctors is a step in the wrong direction at a time when the national dialogue is seeking improved management of mental health conditions.

Without question, we’re at a tipping point in this dialogue. While much remains to be done, allowing this CMS action to proceed puts us back behind the starting line at a time when we should be looking forward. Ultimately, we won’t make true progress if we can’t get the fundamentals right. And telling seniors and disabled Americans that they can’t have access to a range of treatment options for depression is the opposite of progress.

It’s back in the shadows.

Doederlein is the president of the Depression and Bipolar Support Alliance (DBSA), in Chicago, Ill. Totten is the founder and president of Families for Depression Awareness (FFDA) in Waltham, Mass.