I recently ran into a family friend at a coffee shop. After covering all the important hometown gossip, our discussion turned to the future of health care. As a psychologist, my friend expressed concern that in all the talk about reforming the health care system, she hadn’t heard of any plans for mental health coverage. As someone who has seen the positive effect of psychotherapy in people’s lives, I was disappointed to find out that insurance providers place inadequate value on it. Later, a Google search suggested that there isn’t a provision for universal mental health care in the works.

In the threefold healthcare plan that President Barack Obama has outlined, “prevention” is the third step in improving the health care paradigm, after insurance reform and technology advancement. But while “prevention” is illustrated rather thoroughly on barackobama.com — better nutrition, cancer screenings, electronic health records, etc. — the plan entirely disregards the nexus between mental well-being and physical health. According to the American Psychological Association’s website, “50 to 70 percent of visits to primary care physicians are for medical complaints that stem from psychological factors.” These factors are primarily depression and anxiety.

That figure might sound ridiculous. But when you consider that health concerns ranging from blood pressure and ulcers to acne often have a psychological root, those numbers might not actually seem so absurd. Patients confuse these maladies as purely physiological problems — but these issues are really psychological in nature. Rather than searching for a physical remedy, the more prudent decision might be to take a psychological approach. Such a solution might even end up being cheaper in the long run without the costs of exams, medical technology and physical treatment, something Obama’s healthcare plan should consider.

Even current private insurers rarely provide adequate coverage for mental health care. Many insurance plans cap mental health care much more strictly than physical health maintenance. A comprehensive plan for health reform should include coverage for the treatment of mental illness and ought to set limits for such treatment on par with limits on physical medical care. In other words, a patient should not have unlimited visits to a physician but only 15 lifetime visits to a mental health professional.

And the sad irony is that the least financially fortunate, who are more prone than others to mental illness given their destitution, are often faced with meager or no insurance coverage for mental care. These are people who need comprehensive health care plans the most and are the least able to obtain it.

Setting aside socioeconomic disparities and psychosomatic conditions — both of which are important health care realities — there are two additional relevant problems when it comes to psychological affects on physical health: substance abuse and obesity. These problems are widespread in the U.S., and are largely caused by mental vulnerability. It would seem that in the government’s quest to eliminate health costs through “prevention,” minimizing obesity and substance abuse should be relatively easy to facilitate through appropriate psychological attention.

In all the discussion about health care and the government, it seems that mental health care has been ignored by both sides. Maybe it’s because psychotherapy is often difficult to understand or believe, or perhaps politicians and pundits are too myopic to think outside the box about health care reform in general. But as universal health care becomes more and more likely, psychological well-being needs to be thrown into the debate.

It may be that by remaining vague, Obama was hoping to provide Congress with a basic framework upon which the legislature might create a balanced plan that would be more likely to pass into law. Now that Congress is going into recess during August, all congressmen ought to meticulously deliberate on health care reform and take the time to think seriously about mental health care. They’d have to be nuts not to.

Matthew Green can be reached at greenmat@umich.edu.

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