Think healthy: HMOs should give equal consideration to mental illnesses


Published November 9, 2001

The U.S. Senate recently passed the Mental Health Equitable Treatment Act, which will require health insurers that provide mental health benefits to give equal coverage for mental and physical illnesses.

This bill will go to conference with a House bill which is not nearly as comprehensive. The Senate bill mandates that insurance companies allow mentally ill patients the same number of medical consultations and hospital visits as the physically ill. Under the bill, deductibles and co-payments for mental diseases would be identical to those for physical maladies. The House bill lacks these crucial provisions.

The U.S. is presently confronted with a mental health crisis with deleterious effects on individual families and the national economy. Insurance coverage for mental health must be equivalent to that supplied for physical ailments.

According to the National Institute of Mental Health, about 30,000 people committed suicide in 1997. More than 90 percent of people who kill themselves have a diagnosable mental disorder, commonly a depressive disorder or a substance abuse disorder. Approximately 2.2 million American adults, about 1.1 percent of the population age 18 and older are diagnosed with schizophrenia in a given year.

The suicide rate in young people has increased dramatically over the last few decades. In 1997, suicide was the third leading cause of death among 15 to 24 year olds. Some may argue that the bill won"t significantly help this population, as the health coverage is slated for workers" benefits and not many young adults with severe depressive disorders hold jobs that provide these benefits in the first place. On the contrary, many young people in this age group are covered under their parents" insurance and many of their parents probably do hold jobs that provide these benefits.

The bill"s proponents argue that mental illnesses are biological in origin and individuals who suffer from them have as little control over their conditions as those who endure congenital heart defects. While experts have not yet confirmed this theory for many mental illnesses, it is reasonable to suspect tha there is some biological element in most mental disorders.

Supporters say the bill will achieve its objectives without substantially increasing costs for the insured. According to the American Psychiatric Association, insurance premiums would rise .9 percent, costing employees $1.32 extra per month.

But the bill does have its drawbacks. For example, it would expand the authority of HMOs, giving patients less freedom to choose the doctors they want and less money with which to go outside the system. Also, there is no proposed cap on treatment spending and no definition of an illness" cure, encouraging abuse of the benefits.

A press release issued by the National Alliance for the Mentally Ill, voiced this widespread worry: "Already, the stepped-up attention to fraudulent psychiatric Medicare and Medicaid billing by federal authorities has begun to cast serious suspicion on the whole mental treatment enterprise. Such a backlash will harm the mentally ill with genuine claims on effective treatment for their well-defined illnesses."

While valid, this concern does not take away from the fact that a vast amount of people are suffering from mental illnesses for which they are not insured and for which they have yet to receive adequate treatment. If the bill is passed with sensible controls, it will help alleviate the suffering of many.