“I’ll give you everything I’ve got for a little peace of mind.” -John Lennon
In the wake of major criticisms by the Surgeon General and the World Health Organization, the federal government is now considering the grave state of mental health care in the United States.
“Remarkable treatments exist and that’s good,” President Bush said last year in a University of New Mexico address, “yet too many people – too many people – remain untreated.”
This sentiment – one he reiterated in his State of the Union address – is nothing new. As governor of Texas, Bush, a longtime supporter of increased coverage for the mentally ill, signed a bill in 1997 requiring health plans to provide fair treatment for eight severe mental disorders, including schizophrenia and depression.
Recently, the president announced his support for Senate legislation requiring health insurance plans to provide mental health coverage equivalent in quality and extent to physical health coverage. This would mean equal co-payments and visitation limits for treatments regarding mental disorders and physical disorders. Twenty-three states, including California, have passed mental health parity legislation. The federal government now plans to nationalize the issue.
Bush also created a 15-member commission last year to recommend methods for improving national mental health care, chaired by Michael Hogan of the Ohio Mental Health Dept.
Within the next year, the Senate is expected to vote on a bill authored by Sen. Pete Domenici, R-N.M., which would provide such health care benefits. Although the bill is still being edited by co-authors, Domenici hopes to provide coverage for all of the 200+ mental health disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, used by U.S. medical practitioners. The late Sen. Paul Wellstone was a co-author of the legislation, which may soon become a legacy bill.
A Case of Necessity
The statistics are staggering: Over 54 million Americans suffer from mental illness. Nineteen million of these are cases of depression and other anxiety disorders. Less than eight million seek treatment. Forty-four million Americans currently have no health coverage and a disproportionately large number of these are mentally ill, due to the difficulties that mental illness presents in finding and maintaining employment.
A recent report by the World Health Organization indicates that one in four people in the world will be affected by a mental or brain disorder in the course of their lifetimes and that 450 million people are affected globally by neurological disorders. According to the WHO, with proper mental health care, 80 percent of people with schizophrenia could be free of relapses at the end of one year of treatment, 60 percent of depression sufferers could make a full recovery, and 70 percent of epileptics could become seizure-free.
“Political leaders, health care professionals and all Americans must understand and send this message: Mental disability is not a scandal,” Bush said in his New Mexico address.
Perhaps not, but mental health care may become one.
In the U.S., several interest groups are hardest hit by inadequate mental health care. The most heavily burdened group is that of children under the age of 18.
According to a recent Surgeon General’s report, 14 million children are affected by mental illness in a given year; half of these illnesses result in some form of developmental impairment, and less than two million receive treatment. This is due mainly to the fact that no primary mental health care infrastructure exists for minors in the United States.
College students also suffer from a lack of coverage. According to a survey by the National Survey of Counseling Center Directors of 274 polled nationwide, over one-third reported one or more suicides on campus. The National Mental Health Association reports a “generally accepted rate” of 7.5 suicides for every 100,000 students on a campus; according to the association’s research, suicide is the third-leading cause of death among 13- to 24-year-olds, and second among college-aged students.
Within the last three years, schools like M.I.T., the Universities of Maryland, Columbia, Michigan and Pennsylvania have all reported a 20 to 50 percent increase in demand for mental health services. Many students rely on the health insurance their university offers; many of these schools have a waiting list of two or more weeks to see a counselor, and most universities do not offer any sort of long-term treatment.
In the face of rising costs for mental health services some states, like Michigan, have considered privatizing care, raising concern that such services would go to the lowest bidder.
The Price of Care
Bush has not announced his support for the Domenici bill directly, but has made it clear that he stands behind the concept of improved mental health coverage, with the stipulation that any such bill must not significantly increase the cost of health care in the United States.
While proponents of the Domenici bill claim that health care costs would increase by only 0.9 percent, many hard-line Republicans and business lobbyists are heavily opposed to the bill. They claim that it would add billions to the price of national health coverage. Their concern is understandable.
In 1998, most business spent roughly $4,000 per year, per employee on health care. In 2001 that number had risen to $5,162 and similar hikes occur each year. According to a report by the federal Centers for Medicare and Medicaid Services, this figure will continue to rise by 7.3 percent annually through 2011, reaching a total of around $11,500.
Over the past several years, Congress has mandated other health care benefits such as an extra day of hospitalization after a woman gives birth and payment for mammograms. While these advancements have improved national health care, businesses claim they are feeling the burn.
In response to increased costs businesses have, in the past, attempted to work out deals with managed health care organizations known as gatekeeper arrangements in which the HMO required patients to get clearance before seeking health care from specialists or undergoing additional procedures or tests.
These arrangements shattered under patient complaints.
Now businesses may turn to a new type of health plan known as “defined-contribution insurance.” Under this type of plan a company will cover the first $1,000 or so of a family’s annual medical costs. The next $500 will be the family’s responsibility and any costs above and beyond this initial $1,500 will be split between the employer and employee.
Regardless of whether many companies adopt this policy, even managed care insurance premiums are destined to rise in the coming years, due to the slump in the national economy.