Minds and Hearts: Priorities in Mental Health Services

By Boyle, Philip J.; Callahan, Daniel | The Hastings Center Report, September-October 1993 | Go to article overview

Minds and Hearts: Priorities in Mental Health Services


Boyle, Philip J., Callahan, Daniel, The Hastings Center Report


To care for people with mental illness is to live in a world of inescapable misfortune and tragic choices. Mental illness strikes with a random yet pandemic quality, producing at its worst nightmarish hallucinations, crippling paranoia, unrelenting depression, a choking sense of panic, and uncontrollable obsession - and even in its milder manifestations it produces many other oppressions. Approximately one in three Americans will experience some form of mental disorder at some point in their lives, and according to one estimate, one in every 6.4 adults is currently suffering from some form of mental illness.[1] This figure comes to 41.2 million people and climbs higher if substance abuse is included. A significant number of these - more than 1.7 million Americans - suffers from a persistent and severely disabling condition, such as schizophrenia. The costs of caring for these patients and those whose illness is episodic, curable, or only mildly debilitating have reached $136.1 billion per year.

As if the tragedy of illness were not pain enough - for individuals with mental illness, their families, and the community - as a society we face additional pain as we are pressured to choose which ill people we will treat and with what services. As health care reform moves forward with the aim of providing affordable, appropriate health care that is available to all, there will be pressure to examine whether any health services are less important or dispensable than others. It is unlikely that mental health will escape scrutiny. Indeed, one of the most serious issues that will have to be faced by the mental health community is how it can participate in the health planning process.

Given the past and present dismal plight of mental health services, both its patients and its providers have good reason to be concerned about reform. Historically, mental health services have not received the same support as physical health.[2] private and public funding permit "carve outs" in mental health coverage that provide fewer benefits than those allowed for physical health. Private insurance customarily restricts mental health benefits more stringently, setting caps on numbers of hospital days or outpatient visits, or imposing annual or lifetime dollar limits for mental health services.[3]

Insurance policies, for example, typically limit hospital care for persons

with mental illness to thirty days a year, according to a 1991 survey of employer-provided coverage conducted by the Health Insurance Association of America. While 99 percent of insured individuals have private coverage for inpatient mental health care, in only 37 percent of these cases is the mental health coverage' equivalent to that for other illnesses.[4] The same is true for outpatient care: although 98 percent of persons with private insurance are covered for outpatient mental health benefits, only 3 percent have coverage equivalent to that for other illnesses. Psychotherapy sessions are generally limited to ninety visits a year with a 50 percent copayment. Health maintenance organizations (HMOs) customarily restrict therapy to thirty sessions a year with a 50 percent copayment.[5] Spending caps (lifetime or annual) limit coverage of disorders such as schizophrenia, bipolar disorder, and autism because of the presumed high cost of treatment and uncertainty of successful outcomes. Unfortunately, mandates generally provide uniform limits on services without regard to the severity of the condition or the effectiveness of the treatment.[5] The public system's provision of care is not much better. With strained, if not reduced budgets, and fragmentation in services among levels of government, those in need of mental health care are often either stricken from the rolls or simply fall through the cracks of a highly fragmented system. In a word, mental health continues to be the poor stepchild of the health care delivery system. As someone once quipped, mental health care is more likely to be a "plea for service" than "fee for service. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Minds and Hearts: Priorities in Mental Health Services
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.