Questions about access....

I am going to tell you a story.  One that I think happens in Florida.  As someone who has been a consumer of medical/mental health services, I know it to be true.  The rules for Medicaid in Florida are as follows:  You have to be disabled (and have Social Security Disability) or be 65 years of age in order to get Medicaid.  This means that you have to be able to prove to the Social Security Administration that you are unable to work in order to qualify for Medicaid.  If you have been turned down for SSDI, you are not eligible for Medicaid.  And it is pretty much my experience that the process for obtaining SSDI is long and drawn out.  And most people who apply are turned down the first time. 

So, taking my understandings into account, I am going to talk theoretically about access to mental health services. Let’s say you are a parent of an adult child who is no longer able to be covered on the parental insurance policy.  And this child starts to show some problematic behaviors.  They are talking to themselves.  They have become very argumentative.  And you start to become concerned for your physical safety.  Or their physical safety.  Maybe this child’s behavior rises to the level that they are able to be committed.   Or a child becomes profoundly depressed, and expresses suicidal ideation.  Which also results in hospitalization.  So, they are hospitalized.  After they come out of the hospital with a small amount of medication.   And maybe a prescription for one more month.  

Here are the questions:  The child who is a paranoid schizophrenic is probably going to be able to prove to Social Security Disability that their condition is disabling. Or maybe they won’t.  Will the severely depressed individual be able to do the same thing that easily?  And what if the treatment of the depressive condition makes them capable of working?   But they don’t have a job.  And therefore don’t have insurance yet.  This means that they are in the same position as before the hospitalization.  No insurance.  What does that do to access to services?  It really does make it harder.  Especially if the parent is not able to pay for services. Medicaid is not available in this state for those under 65 years of age. Period. Unless you are pregnant. And mental health services are difficult to obtain by those without insurance.  Even if you utilize what is available on a sliding fee scale.  As someone who tried to obtain an appointment for sliding fee scale therapy options, I found that I had to be placed on a waiting list. 
 

Unless I do not understand something here, this could be complex.  And because of Sandy Hook, I wonder what the access means for the potential for another Sandy Hook?   What do you think?  How can we make sure that basic access to care is out there?  How does lack of access to insurance impact the ability of people to get help?  And how does that put our loved ones in danger? Let me know what YOU think.  And please, let me know if I have anything factually wrong here.  I really want to know.