Reuters Health Information 2007

U.S. Moves Toward Equal Treatment for Mentally Ill

By Joanne Kenen

WASHINGTON (Reuters) Oct 25 - Some days, Mrs. J can't travel further than her bed to her chair, her chair to her bed. Her arms and legs work just fine, but she is too depressed to move.

Depression runs in her family. Her mother committed suicide. So did one of her sisters. Her only child took his life five years ago at age 35. (She asked that her name be withheld because her grandchildren have not yet been told how their father died.)

At age 59, the college-educated Alabama resident has not been able to work for years, and the health insurance she gets through her husband's factory job no longer covers the therapy sessions she says she needs.

Congress is addressing situations like Mrs. J's with a bill to require health insurance plans to treat mental illness the way they treat any other disease.

Known as mental health parity, the idea is making progress in Congress after a decade-long campaign by advocates for the mentally ill, a sign that U.S. society is slowly breaking down the stigma of mental illness.

"There's a palpable, huge change in the attitudes of people," said Sen. Pete Domenici, a conservative New Mexico Republican whose frankness about his daughter's schizophrenia helped fellow lawmakers understand the struggles that even families with good insurance endure.

Across the globe, in rich countries and poor with all kinds of insurance systems, mental health is undertreated and its prevalence is often underestimated.

A bill passed the Senate unanimously last month that would require insurance companies to have the same fees and co-pays as for other diseases, give the the same access to medicine, and have the same annual and lifetime caps and limits.

The U.S. House of Representatives is working on companion legislation with more expansive mental health coverage requirements. But requirements, or insurance mandates, are more controversial and conservatives generally oppose them.

Patient advocacy groups say the odds are good of a final deal this year, although there is no guarantee that the legislation won't derail again. Still Domenici and a lead House sponsor Republican Rep. Jim Ramstad of Minnesota have both expressed their determination to see the bill signed into law before their retirements next year.

For people like Mrs. J, parity rules would make a huge difference. For years she had to pay half the cost of each therapy visit, instead of the $15 fee for any other doctor. Some years she exhausted her annual limit on therapy sessions -- which would not apply to other medical conditions -- and had to interrupt treatment or scrape together money to pay for it herself until the start of a new year.

"Can you imagine a diabetic who needs to see a doctor frequently, who may need hospitalization, who has all sorts of problems, being told he can only have one more visit this year and then we won't see you again -- and it's only July," said Dr. Carolyn Robinowitz,(cq) president of the American Psychiatric Association. "Or if we told a patient, you had one heart attack this year. We won't treat you if you have another."

A little over a year ago, the Alabama woman reached her policy's lifetime limit on therapy, a limit that is far more stringent than for other medical and surgical health problems.

"I was told that they weren't going to cover me anymore," she said in a telephone interview arranged through Mental Health America, an advocacy and education group.

Her husband of 41 years, a 60-year-old laborer, puts in hours of overtime to pay for even limited ongoing care

Advocacy groups know that the legislation, if enacted, won't solve all problems of access to mental health care. It exempts businesses with 50 or fewer workers, does not affect the Medicare health program for the elderly, and doesn't increase access for the 47 million uninsured.

"This is a practical solution. It's not a perfect solution," said Domenici. But it will help millions of families.

Andrew Sperling, legislative director for the National Alliance on Mental Illness, a lobbying and support group, said, "We'll still have gaps in the system -- adequacy of networks, insurance, patients rights. But that's part of comprehensive health care reform. Now we'll be having the same fights as everybody else."

For Mrs. J, it can't come too soon. She switched therapists recently, and said she is taking "baby steps" toward recovery.

Ironically, the plan would pay if she were hospitalized, although it would cost more than outpatient therapy. "I've had three hospitalizations," she said. "I don't want anymore. I want to stay home. A mental hospital -- well, it's not a nice place to be."

Reuters Health Information 2007.

© 2007 Reuters Ltd.

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