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The commission also pointed to studies showing that mental illness and substance abuse are the two leading causes of disability in North America and Europe, together accounting for more than one third of all claims. But disabled--and usually unemployed--persons who seek care in the US often risk their Medicaid healthcare benefits if they get well enough to rejoin the work force.

"They can't afford to get back to work because they lose their health insurance. We have trapped people in a system that is at least as dysfunctional as the old welfare system," said Hogan, who is the director of the Ohio Department of Mental Healt