One disturbing aspect of the great debate over the way health care should be financed and delivered is the low priority given to the care of people with mental illness. This bias, which results from an artificial distinction between "mental" and "physical" disorders, is embedded in the president's proposal for health-care reform.
The Clinton plan would finance only 60 days of inpatient care and/or 30 outpatient psychotherapy sessions a year. A patient enrolled in an HMO would pay $10 a visit for "medical maintenance" and $25 a visit for psychotherapy. A fee-for-service plan would require patients to pay 50 percent of the cost of each psychotherapy session, while a preferred-provider plan would offer no coverage for outpatient psychotherapy. Thus the 20,000 St. Louisans who can't afford the mental health services they need may still not be able to obtain adequate care.
Mental illness is our third most disabling health problem, behind only cancer and stroke. The total estimated cost in 1991 exceeded $136 billion. Mental illness affects 50 million Americans and one out of four families. A single disease, depression, afflicts one out of every 20 people at some time in their lives. Another disease, schizophrenia, affects as many people in the United States as the combined populations of Kansas, Oregon and Mississippi. At least 270,000 people in metropolitan St. Louis are currently mentally ill; many receive no treatment.
Despite these statistics, ignorance about these disorders is widespread. The National Alliance for the Mentally Ill found that 71 percent of Americans believe mental illness results from emotional weakness, 65 percent attribute it to bad parenting, more than a third cite sinful behavior as a cause, and 45 percent say the mentally ill are responsible for their own symptoms. A Missouri Department of Mental Health poll revealed that two-thirds of Missourians confuse schizophrenia with multiple personality - two different diseases - while 40 …