The Institutes of Mental Disease (IMD) Exclusion Is Absolutely Discriminatory

In a recent letter to all of my state representatives I have expressed my outrage over the outdated and absolutely discriminatory exclusion in the Medicaid/Medicare system that has REFUSED to properly treat those with severe psychiatric illnesses like schizophrenia and bipolar 1 for over 50 years. New legislation has been introduced to gently ease the IMD Exclusion open just enough to meet the needs of those suffering from Substance Use Disorder (SUD) but it will continue to keep the healthcare gate tightly closed for those with Serious Mental Illnesses (SMI) who are between the ages of 22 and 64. These serious mental illnesses are just as devastating, disabling and deserving of treatment as SUD.

The IMD Exclusion has been preventing those that need psychiatric care the most from receiving treatment for over fifty years. We need to end it today, and get those people who are living with serious mental illnesses plugged into treatment options that work. This does not mean returning to the dark ages of forced commitments in unsanitary and inhumane state ran facilities that were cruelly over used and desperately under staffed. No, it is 2018 and it is time we fix this system. We are an advanced civilization, can we not come up with a way to secure Assisted Outpatient Treatment (AOT) for those living with serious mental illness? Is it too much to ask to have larger facilities that have more than the cut off of 16 beds? Facilities that are well staffed with personel that are trained to provide compassionate professional care for those in a mental health crisis. Most crisis situations need more than the standard 72 hour mental hygiene hold to be properly treated. Unfortunately that limited 72 hours does very little to stabilize a patient with schizophrenia in psychosis which can last weeks or months.

I am all for the treatment of Substance Use Disorders but I insist that that same coverage needs to be extended all the way to include those that live with Serious Mental Illness too! It doesn’t make sense to exclude them from receiving treatment, untreated schizophrenia or bipolar disorder will lead to many of the same challenges someone with a SUD will experience. Both will have problems functioning, maintaining relationships and securing employment. When untreated, these illnesses just like SUD,  can leave the one living with them feeling isolated and suicidal. Its time as a nation we address ALL of our mental health needs – not just some. This current proposal of only treating Substance Use Disorders is discriminatory.

Being proactive saves money as well. This makes sense financially for all states. Just like in physical health it always saves money to be proactive rather than reactive. That is why physical wellness checkups are almost always covered 100% by most insurances. Catching serious mental illness early and being proactive in its treatment will save us money in the long run. I encourage everyone who reads this to learn as much as possible about this issue. We need to as a nation decide that treating our most vulnerable citizens so inhumanely is morally wrong. We can and must repeal and remove completely this IMD Exclusion. It is a serious roadblock to getting millions of people the care they need.

Please write your local state Representatives, Senators and Governor. You can find all of their contact information by using this free tool. By simply inputting your address it will give you the contact details for all of your local, state, and federal officials : Common Cause Find Your Official Tool.  Let them know you want to see them working on this legislation and that you care about those that live with serious mental illnesses in your communities. Please push them to make this country a kinder more compassionate place to live for those with SMI. A place that gives them just as many options for care as any other disease or disorder and gives them the medical insurance coverage they need to receive it. Its time to end this suffering and medical discrimination. No diagnosis should exclude anyone from receiving quality healthcare in America.

Learn More About Pending IMD Legislation That Continues To Exclude The SMI:

S. 1169: Medicaid Coverage for Addiction Recovery Expansion Act

H.R. 2687: Medicaid Coverage for Addiction Recovery Expansion Act

Other steps you can take today that will help end this archaic and often abusive system is to sign the Treatment Advocacy Centers Petition to repeal the IMD Exclusion.

I would also encourage you to join The National Shattering Silence Coalition. img_6170Their Mission Statement is “NSSC is an alliance of diverse individuals and organizations who are uniting to ensure that mental illness, health, and criminal justice systems count those with SMI, SED, and their families in all federal, state, and local policy reforms. We are voices for the 10 million adults and 7 million children living with and dying too young from serious mental illness.” It is a great group of people working hard to change the world for those living with SMI and SED.  Click Here To Join The NSSC.

The following letter was sent to West Virginia Senator Shelley Moore Capito as well as Senator Manchin, Governor Jim Justice and Representative McKinley. I encourage you to reach out to your state officials today and express your discord with the current broken mental health system that is neglecting the needs of those living with serious mental illness.


Senator Shelley Moore Capito 

500 Virginia Street East
Suite 950
Charleston, WV 25301

Dear Senator Capito,

I am a concerned constituent of the great state of West Virginia. I am writing to you today to express my concern about the lack of services our state presently offers those that are living with serious mental illnesses like schizophrenia and bipolar. I do believe that we can work together to make a more positive future for those that live with chronic psychiatric illnesses.

Unfortunately, research shows that all too often those with serious mental illnesses go untreated which often leads to a life of unemployment, vagrancy or incarceration. Giving these people the option for quality Assisted Outpatient Treatment (AOT) or long-term psychiatric care and hospitalizations when needed, would ensure a new beginning for those living with serious mental illnesses in our communities. Not only would it enhance the quality of their lives but help them become more productive members of our communities.

Research shows that treatment works. It is often those that are left untreated who suffer in silence, unable to function or participate in society at the potential they could if allowed treatment. Ending the unnecessary hurdles that come along with finding quality treatment would begin by removing the over 50 year old Institutes of Mental Disease (IMD) Exclusion from Medicare/Medicaid. This exclusion ostracizes those from the ages of 22-64 who need care for psychiatric illnesses in our society. This segregation seems extremely discriminatory to me. Can you imagine if all cancer patients were excluded from coverage in our healthcare system solely based on their diagnosis? It is no less an atrocity for a person to be denied services based on a diagnosis of schizophrenia.

On a broader scale, the IMD exclusion restricts the size of facilities to serve those with these disorders as well making treatment harder to find. By keeping much needed beds in shortage we inevitably end up  funneling our mentally ill to other less desirable places like county jails and state prisons to be warehoused. We do this because we quite simply have no better options or places to treat them in place currently. This is barbaric, inhumane and injustice. This continued abuse of the ill in our state violates one of the core moral principles in this country – to protect the weak and defend the defenseless and to give consideration to the minority.

I am writing you today to urge you to use your office as a platform to protect and serve these very vulnerable residents of West Virginia. They truly need your help. They need more treatment options, more psychiatric hospitals and more judicial diversion programs that get them out of jails and into facilities that treat their illnesses’ with compassion and understanding. Much work is being done in the State of West Virginia to combat the current heroin and opioid epidemic. Studies show that 50% of those with Substance Use Disorder (SUD) also live with a mental illness and vice versa. You must consider doing what you can to repeal this antiquated IMD Exclusion and get people treated appropriately for their underlying mental illnesses along with their Substance Use Disorder.

I look forward to hearing from you and working with you to change the landscape in West Virginia to be a more compassionate and responsive environment to all of our states residents mental health concerns, especially those that live with the most severe of psychiatric illnesses like schizophrenia and bipolar. We must educate, advocate and communicate on their behalf. I have made this my life long calling because I am the mother of a young man who lives with schizophrenia. His challenges and battles have inspired me to take up this cause and make the world a kinder more compassionate place for him to live. I started a Peer Group and Ministry all devoted to serving those with serious mental illnesses in my community. I advocate on their behalf on several different platforms and serve on several committees for the National Shattering Silence Coalition (NSSC) as well as Chair their Emergency Action Committee. This is me, reaching out to you, to start a dialogue about changes we can make together in this state to make it a better place to live for our current residents living with serious mental illnesses. And I encourage you to be a champion in this area, that type of bravery will attract others to join in on breaking down this 50 year old wall that has separated so many from receiving the care they deserve.

I look forward to your response on these issues and welcome any questions or concerns you may have on this letter or my serious mental illness advocacy. I know you care about our State of West Virginia and uphold your office with great reverence. Thank you for your service and your consideration on these matters.


Tamara Dalrymple


Copies of this letter have also been respectfully submitted to:

Governor Jim Justice 

Office of the Governor
State Capitol, 1900 Kanawha Blvd. E
Charleston, WV 25305

Senator Joe Manchin 

900 Pennsylvania Ave., Ste. 629
Charleston, WV 25302

Senator Shelley Moore Capito 

500 Virginia Street East
Suite 950
Charleston, WV 25301

Representative David McKinley

408 Market Street
Parkersburg, WV 26101

Contact Information:

Author / Serious Mental Illness Advocate Tamara Dalrymple

3 thoughts on “The Institutes of Mental Disease (IMD) Exclusion Is Absolutely Discriminatory

  1. i pray blessings for you in all your God lead efforts along the lines of respectfully and professionally caring for those who deserve nothing but the utmost. I fully trust that our heavenly Father will bless the all of your ministry. Praise you Lord! God love you Tamara! This is truly awesome*

    1. The Word tells me that as a Christian I must care for those that are suffering. It is a my duty to take this on – head on – and fight for their rights.

  2. Generally I am not a fan of government-run health care, but serious mental illness leaves no practical alternative. Government exists to protect our rights. When an adult’s mental state prohibits rational thought, that adult must be forcibly confined and helped. Only government has the authority and power to do that.

    Once our society use to help such people. Then, using drug treatment and the horrors of poorly run mental institutions as an excuse, we stopped. Given the dire circumstances the homeless face, many of which have severe mental issues, it seems to be the right time to revisit the problem.

    Thank you for your advocacy.

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