A Positive Link of Mind and Body

The Health Insurance Reform Act, passed by unanimous vote in the Senate last week, gives equal weight to mental and physical illnesses in our health care system. Unfortunately, this portion of the bill is hotly contested. This is not the first chance Congress has had to end the historic discrimination against people with mental illness. I have been an advocate for mental health reform for more than 20 years, and each time there is an opportunity for real progress, the same objections are voiced by the same interest groups.

The main objection to parity for mental illness in health coverage is the belief that insurance costs will escalate dramatically. The fact is that it is much more cost effective to diagnose and treat mental illnesses in the early stages than to allow these illnesses to develop into serious problems that may require long-term hospitalization. Mental illnesses, like physical ones, can be defined, diagnosed and treated. Research has made clear that some major mental illnesses are related to chemical or structural problems of the brain. What we have learned about the brain just in the last decade has led to new medications and treatments.

Moreover, there is increasing evidence from many of our larger corporations--McDonnell Douglas, Digital, Honeywell, and First National Bank of Chicago, to name a few--that a comprehensive, managed mental health benefit is effective in dealing with mental health problems and also reduces the total cost of health care.

Appropriate mental health care is not free, but lack of proper care has devastating consequences, financial and emotional. In the workplace, both employers and ill employees suffer, due to absenteeism, higher turnover of jobs and diminished quality of work. Major depression now accounts for more “bed days”--people out of work and in bed--than any disorder except cardiovascular disease. This is unnecessary, when we now know that with therapy and medication, people can be treated for depression and live more normal lives as contributing members to society. And research has shown that therapy does not have to be long-term to be effective.

When we don’t pay for mental health services through the health care system, we pay for the lack of these services through higher costs of medical care for physical illnesses, through the welfare system, the criminal justice system, in support to our homeless, in addition to lost productivity in the workplace and losses due to premature death from suicide. The indirect costs to society due to lack of treatment are far greater than the direct costs from treatment.

In the home, family members, including children, are affected emotionally. We must never lose sight of the human costs of decreased opportunity for people with mental illness to participate in the major activities of daily life in their communities. The cost of pain and suffering is incalculable.

In 1994, when we were working on health care reform, a national survey showed that 78% of people thought that mental health should be covered the same as physical health. This same poll showed that supporting this kind of legislation was the politically popular thing to do. There was 23% more support for a health care reform bill that included a mental health benefit than for one that did not. This indicates to me that the public was far ahead of Congress in wanting to help those who suffer the injustices of our current health care system. The Senate is now catching up with public opinion.

Individuals with mental illness long have experienced stigma and discrimination as a result of prevailing myths and false stereotypes. They have been excluded from the mainstream of American life in housing, employment and health care. We can correct this if we choose.

Every day we hear more and more from all levels of the health care community about how intricately linked are the mind and body--a positive outlook can make a tremendous difference in how quickly and fully someone can recover from a physical ailment. Creating a health care system that reflects parity between physical and mental health acknowledges the need to see people as whole human beings, and it recognizes the worth of every person regardless of his or her disability.