SUPERMAN IS DEAD...KILLED BY A SUPERLUNATIC, AN ESCAPEE FROM A COSMIC INSANE ASYLUM. This was the headline in papers around the country in September. Here in Georgia, in October, the news was SIX FLAGS OVER GEORGIA TO OPEN NEW HALLOWEEN ATTRACTION: "ASYLUM OF HORRORS."
It seems as though we have been fighting myths, misconceptions, and stereotypes about mental illness for decades; indeed, many of us have! And yet much has changed.
A quick response from mental health advocates clarified the fact that Superman's killer is really a cosmic criminal; the new Halloween attraction at Six Flags became the "House of Horrors."
We are learning a great deal about how to change public attitudes, influence the media, and shape public policy. Our most important challenge of the decade is to ensure that as the debate over national health care reform proceeds we win a victory for mental health in any new plan.
There is much going on in the field that offers great hope to those who suffer from mental illness and to their families. Many of the developments of the last decade have important implications for the debate over including mental health in health care reform.
Progress in understanding the biology of the brain has been nothing short of amazing. We now know more about how messages are sent from one nerve cell to another. We can take pictures of the brain without surgery or injections. We can measure activity related to different emotions and behaviors, and we have learned much more about where medicines act in the brain.
Through careful clinical trials, we have used this knowledge to significantly improve treatment. New medications are helping people suffering from depression and anxiety. Special kinds of psychological therapy are also proving to be effective in treating depressed individuals. And we have new drugs that work for some patients with schizophrenia who have not responded to other kinds of treatments.
One success story involves a thirty-seven-year-old man suffering from schizophrenia who, for almost twenty years, was in and out of psychiatric hospitals. He heard strange voices and preached to other patients that his prayers would save the world. In 1989 he began treatment with one of the new drugs, Clozapine; today he is significantly improved and about to become a college graduate.
The new treatments reduce symptoms and restore personal effectiveness--not for all patients, but for many; not every time, but often; not forever, but for long periods of time. Yet many patients who could benefit from treatment are not receiving it.
Even those with the most severe mental illnesses could significantly improve through treatment with the new medications and rehabilitation. Yet the hope of recovery is denied to hundreds of thousands because of lack of access to care.
Many who could benefit from advances in treatment remain incapacitated because they have no way to pay for care. Hundreds of thousands more and their families face serious economic hardship because of limited coverage under most existing insurance plans. I often receive letters from distraught family members describing their heavy financial burdens and their frustrating efforts at obtaining care for their mentally ill loved one. The stark reality is that our current system of public and private insurance discriminates badly against those in need of a broad array of mental health services.
As most of you know, my greatest disappointment after leaving the White House was the failure to implement the Mental Health Systems Act. A wonderful opportunity to create landmark change in the financing and delivery of mental health services was lost. However, I am proud and pleased that, because of the efforts of many mental health organizations, some of its most significant principles were incorporated into new or existing programs throughout the 1980s.
Small but significant victories were achieved in the use of Social Security Insurance and Medicaid to support people with severe mental illness in the community, and such programs as the Green Door in Washington, D.C., became possible. The Fair Housing Act and the Americans with Disabilities Act now prevent discrimination against those with mental disabilities. Slowly, but much too slowly, those with mental or emotional problems are being specifically included in programs designed to protect and support them.
Today we are at a crossroads. We have an opportunity to bring mental health into the mainstream of our nation's health care system. We cannot afford to fail.
We have new strength in Congress. The House working group on mental health can serve as a focal point for marshalling our efforts. We have important new organizations such as the National Alliance for the Mentally Ill and the Anxiety Disorders Association of America; and many others, such as the National Mental Health Association, are stronger and more effective than ever before. We even have a new administration in Washington. Most important, national mental health organizations have joined together to form a coalition to influence the debate over health care reform.
I want to emphasize that I fully support the message: "Health care reform without equitable mental health benefits is no reform at all." Embodied in this message are three key principles that must guide all our activities as we look toward the year 2000. First, we must end discrimination against those with mental disorders. Discrimination has denied those who need it access to appropriate services for far too long, and it continues to limit resources available to pay for care. The stigma of mental illness remains all too pervasive in our society. We need more people like Patty Duke and William Styron to speak openly about their struggles with mental illness--particularly their treatment and recovery.
Second, we must recognize that to be healthy, one has to be mentally healthy. Mental health is an integral part of every person's health. Awareness of mental health problems needs to permeate the health care system. Primary-care physicians, nurses, and physician assistants must have sufficient knowledge about mental health and the interdependency between mind and body in order to be able to determine when intervention is necessary and who is best able to intervene.
Too few outside the mental health field understand the nature of mental disorders or how treatable they are. Not only those in medicine, but also policymakers, other health care providers, and the general public need to know more about advances in treatment. We in the mental health field have a responsibility to help bridge the gap.
Finally, we must recognize the need to direct our resources in new ways. Appropriate mental health care does not cost too much: but lack of proper care has emotional and financial consequences. Investing in early intervention, treatment, and follow-up care will prevent far more costly disability and possibly even premature death by suicide.
It is time to unite behind a common vision of our historic mission, which transcends special interests in the field. The mental health community has a critical role to play in promoting a society whose individual members are healthy in mind and body. We must not waver in our support of people with the most persistent disabling mental illnesses. We must ensure that these individuals have the comprehensive, coordinated services they need to live in the community and the resources to obtain more intensive care in times of crisis.
We cannot turn our backs on the millions of other Americans--young and old, rich and poor, of every race and ethnic origin--who at some point in their lives will need some kind of treatment for a mental health problem that can be reversed.
You and I know these people; they are our friends, our neighbors, our colleagues, members of our families, ourselves. They could be
* a young girl in Homestead, Florida, whose home has been destroyed by Hurricane Andrew. She has nightmares, has trouble sleeping, suffers from stomach aches, and refuses to go to school. With the help of therapy, she is able to conquer her fear about another hurricane. Her physical symptoms and nightmares gradually decrease, and she is able to go back to school.
* a 50-year-old father of two children who loses his job. After three months of looking for work, he becomes despondent and withdrawn and stops searching for employment. His family convinces him to see a physician, who refers him to a psychiatrist. After treatment with medication and psychotherapy, he is able to resume his search for a job and becomes successfully employed again.
Our advocacy must embrace all those who suffer from mental health problems. We must not provide for care based only on a hierarchy of pain. We must actively lobby for fair and equitable coverage under any plan of health care reform for everyone who is in need of mental health care.
For each of us, this means an advocacy of inclusion, a willingness to pull together rather than pull apart. We can strengthen our ranks beyond the sum of our individual numbers. We must speak with a clear, consistent, and unified voice. And together we will ensure that under any health care reform, the following principles are embraced:
1. Mental health must be integrated into every health care reform package.
2. Any reform must ensure the availability of a broad array of mental health services to all people experiencing mental disorders.
3. Mental health benefits should be based on the same principles as, and subject to no greater limitations than, other health care benefits.
4. Promotion, prevention, and follow-up activities are as essential as the delivery of acute care.
5. The role of the individual in determining a plan of treatment must be viewed as central and never ignored.
6. Mental health services must meet the needs of the individual regardless of age, race, ethnicity, language, or gender.
7. Prevention of unnecessary treatment and assurance of quality care must be monitored through careful review by competently trained professionals.
The task before us will not be easy. It will be a struggle against ignorance; against entrenched interests; against the massive inertia of the health care system; and, indeed, against some of the cherished traditions of our own respective organizations. But we must always keep in mind what this struggle is about:
* individual human dignity;
* the recognition of the worth of every person, regardless of what disability he or she may have;
* the need to see people as whole human beings;
* the right of people to enjoy equal opportunity and equal treatment in all aspects of life, including health and mental health care;
* the importance of reducing dependency for those who are suffering from mental and emotional problems;
* the creation of new opportunities for individuals to become contributing members of their community through treatment and recovery.
Mental health must be a part of health care reform. We can no longer afford to separate the body and the mind. We must unite in support of comprehensive care for the individual as a whole.
There is excitement in the mental health field today. This is a time of hope and opportunity, when new knowledge from research is improving care dramatically. This is also a time when the prospects for achieving equality in access to that care have never been better. Each of us has an important role to play in the struggle. Together, I am confident that we can achieve this new vision by the year 2000.
ROSALYNN CARTER, former First Lady, has worked for more than twenty years to improve the lives of those suffering from mental disorders. As honorary chair of the President's Commission on Mental Health from 1977-1978, she was instrumental in securing passage of the Mental Health Systems Act. Today, she chairs the Task Force on Mental Health Policy at the Carter Presidential Center and each year convenes a symposium to foster cooperation among mental health professionals, advocates, and consumers nationwide. This article is taken from remarks made at the Eighth Annual Rosalynn Carter Symposium on Mental Health Policy, 19 November 1992. |The symposium was made possible by funding from the van Ameringen Foundation of New York and the John D. and Catherine T. Mac Arthur Foundation of Chicago.~
Mental Health Fact Sheet
Who is affected by mental illness?
* One in every five adults has a mental disorder: 41.2 million, excluding substance-abuse disorders; 52.4 million, including substance-abuse disorders (1990).
* Suicide is the eighth leading cause of death and a potential outcome of mental illness and mental disorders.
* 31 percent of Americans report that they or someone in their family has, at some time in their lives, sought the help of a psychiatrist or psychologist; 14 percent say they or someone close to them currently has a mental illness.
* One-third to one-half of younger individuals with severe mental illness also have substance-abuse problems, and at least 70 percent of substance-abusing youth have some type of concomitant psychiatric disorder.
What does it cost to provide mental health care?
* Total expenditures for mental health care (excluding substance abuse) were estimated to be $55.4 billion and indirect costs (loss of productivity, etc.) $73.9 billion in 1988.
* The cost of providing mental health care is not excessive. Studies show relatively low rates of inpatient and outpatient utilization. For example, 85 percent of all patients using outpatient mental health services make 15 or fewer visits.
What are the fiscal costs?
* The cost of not providing treatment for mental disorders is many times higher than that of direct treatment. According to the Alcohol, Drug Abuse and Mental Health Administration, the indirect costs are three times the actual cost of treatment.
* When cost of treatment, reduced productivity, mortality, and criminal justice are all taken into account, the estimated annual economic cost of mental illness and substance abuse combined is $273 billion ($129 billion for mental illness, $86 billion for alcohol abuse, and $58 billion for drug abuse), approximately $1,092 a year for every citizen (1988).
Why don't people have access to mental healthcare?
* 37 million Americans have no health insurance; it is estimated that 50 million are underinsured. For the 153 million people who do have coverage, access is much more restricted for those seeking mental health services than for those with other health care needs.
* Inpatient and outpatient benefits in private insurance for mental illness are far less comprehensive than for physical illnesses--maximum benefits are lower, deductibles and co-insurance higher, and the percentage reimbursed substantially smaller.
* While 98 percent of persons with private health insurance had coverage in 1988 for outpatient mental health benefits, only 3 percent had mental health coverage equivalent to coverage for other illnesses. In general, many limits existed on the number of visits covered (36 percent), total dollars reimbursable (65 percent), and percentage of allowable charges paid (62 percent).
* Only 10.7 percent of all participants in health insurance were covered for partial hospitalization (day or night) and treatment (1986).
* Although 99 percent of insured individuals had private health coverage in 1986 for inpatient mental health treatment, only 37 percent had coverage equivalent to that for other illnesses. |According to 1989 data from the Bureau of Labor Statistics, of 98 percent insured for inpatient mental health treatment from medium and large firms, only 21 percent had coverage equivalent to that for other illnesses.~
* Medical underwriting practices discriminate against persons in need of mental health treatment and those with a history of such treatment. Individuals who have received mental health care are often denied coverage altogether, and "mental disorder" is one of the most common conditions for which a medically underwritten group is rejected for coverage. This often leads to "job lock," as people are afraid to change jobs for fear of losing their health care coverage.
* Many persons with insurance coverage pay for the mental health treatment out-of-pocket for fear they will be denied health insurance if they change jobs and their use of benefits from mental health insurance is disclosed.…