Voluntary Sector

Health Care Providers (nonreimbursed)

Out-of-Pocket Purchase

Other Government Programs

Informal Supports

Very limited availability from voluntary organizations (e.g., American Cancer Society, CancerCare, The Leukemia and Lymphoma Society, Patient Advocate Foundation)

Limited free and reduced-cost health care at some hospitals under Hill-Burton Act


Federal SSI and SSDI programs provide limited funds to certain disabled persons

Some provided by informal supports

The committee notes that in the first half of 2007 (when this report was being written) there was renewed interest in Congress in expanding health insurance to all Americans, and legislation had been introduced in both houses of Congress to achieve comparable coverage of mental and general health care by health insurance (S 558, Mental Health Parity Act of 2007, and HR 1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007). The committee strongly endorses action on this issue.

Restricted Access to Mental Health Clinicians with Special Expertise or Those Located at the Site of Cancer Care

Even when insurance covers mental health services, the ability of a patient to access appropriate mental health care conveniently can sometimes be hindered. Insurance for mental health services is often provided by a health plan that limits the clinicians included as part of the network of providers available to those it insures. When this happens, individual mental health care clinicians, such as psychiatrists and psychologists, who do not belong to and cannot gain admission to that network may not be able to be reimbursed for services to patients insured by the plan (APOS, 2007). This can thwart appropriate mental health care in two ways.

First, individuals with complex comorbid mental health and general medical conditions (such as cancer) sometimes require mental health clinicians with expertise in the management of these complex conditions. In the case of cancer care, for example, a high level of knowledge of cancer-

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