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Policymakers Need Their Heads Examined About Mental Health

by David Kirsh, RN


"If he hears voices in his head, he must be dangerous."

"Schizophrenia means split personality." "If someone gets medication for mental illness they won't ever be creative again."

Popular prejudices about mental illness still abound. But these common misconceptions are paralleled by discrimination from health insurance companies and other administrative institutions which have the power to withhold or curtail treatment. Despite many advances in pharmacological and psychotherapeutic treatment of mental illness, psychiatry remains the neglected stepchild of medicine.

Health insurance companies generally pay out psychiatric benefits in a far more stingy manner than their benefits for other health concerns. Some of their rationale perhaps rests on the prejudice that physical disease can be seen in test results while mental disorders cannot. Another unfounded attitude is that ongoing appointments with psychiatrists and other mental health professionals are just an unlimited excuse to talk and are not "cost-effective."

National health insurance discrimination has been partially addressed by the Mental Health Parity Act of 1996, which requires lifetime caps on benefits for mental illnesses to be no different from those for physical illnesses. There are many limitations on that law, for instance, employers with 50 or fewer workers are exempt, as are those employers whose premiums increase by one percent or more. The Act also does not mandate that an insurance company provide mental health coverage. North Carolina's parity law took effect in 1992, but only applies to state employees. In an effort to expand this trend, Senator Paul Wellstone's (D-MN) has proposed creating parity for substance abuse treatment. Anyone who works in the mental health field recognizes how much impact drug abuse has on mental illness.

Pharmacological treatment of major mental illnesses took a major step forward with the recent discovery of a new group of major tranquilizers that are both more effective in reducing the symptoms of psychosis and much less likely to have severe side-effects.

Whatever problems psychiatric treatment historically had (a la Cuckoo's Nest) or continues to have, there is little question that treatment of schizophrenia, bipolar disorder (manic depression), or other major mental illnesses is better than no treatment. One recent study in the Archives of General Psychiatry found that psychiatric hospitalization of seriously mentally ill individuals reduced the number of those who commit violence by half. For those with concurrent substance abuse and mental illness, hospitalization had an even more pacifying effect. Another finding of the study is that substance abuse is a major risk factor for violence among all individuals, whether mentally ill or not.

The National Advisory Mental Health Council estimated in 1993 that the cost of implementing full parity would be $6.5 billion. However, it would save $1.2 billion in general health care costs and $7.5 billion in indirect costs. These savings would be achieved due to multiple factors, including decreased overall utilization of health care services, decreased absenteeism, and higher productivity.

Mental health and psychiatric facilities are typically under-funded, understaffed and have inadequate facilities for optimal treatment. Informal comparison of general health facilities with psychiatric facilities indicate that mental health patients and their treatment are just not considered as important or serious as patients with physical problems.

But increasingly, the science supports breaking down the distinctions between "mental" and "physical" illnesses. The brain is, after all, an organ in the body and is prone to disorders, too.

  David Kirsh has been a nurse for 13 years and holds a psychological associate license.  

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