People are embarrassed to admit they have a mental health problem or can't afford to see a doctor to treat the ailment, according to the U.S. surgeon general, in the first federal comprehensive report on the subject, released Monday at the White House.
"While mental illness strikes one in five Americans each year, more than half of those who need treatment do not get it, either because they do not seek it or they do not have access to it,'' Surgeon General Dr. David Satcher told a news conference.
The stigmatization of and inadequate insurance coverage for mental illnesses has been documented for some time. But this report puts a federal emphasis on the problem and gives advocates new ammunition to continue to push for parity for mental health coverage. The report described mental illness as "a diagnoseable mental disorder" and says that mental illness, including suicide, is "the second leading cause of disability'' next to heart disease.
The 500-plus page volume is the result of an exhaustive review of more than 3,000 studies on mental illness.
"Despite unprecedented knowledge gained in just the past three decades about the brain and human behavior, mental health is often an afterthought and illnesses of the mind remain shrouded in fear and misunderstanding,'' the report says.
Typically, health plans have some mental health coverage but often it limits office visits and doesn't guarantee hospital stays. And under managed care, mental health coverage is also managed by a company separate from the medical health plan that covers the rest of the body.
"One would hope that we've come a long way from the myth and cliche of the Woody Allen syndrome,'' said Bob Carolla of the National Alliance for the Mentally Ill. "Treatment sometimes involves a combination of talk therapy, but also with several mental illnesses, you're oftentimes talking about medication and there are a range of treatments that have to be individualized."
In recent years Congress and the states have taken up the issue of mental health parity. In 1996 Congress passed a bill with the goal of having physical and mental illnesses treated the same. But that bill had loopholes, advocates say, and they want federal legislation to plug those holes. The 1996 law did not provide for a minimum number of in-patient days or out-patient visits that have to be covered. And it exempted businesses with fewer than 50 employees. The bill was also silent on such issues as co-payments, deductibles and other out-of-pocket costs.
Some 28 states have a form of parity legislation, Carolla said. But the models for the nation, he added, are three bills passed this year in California, New Jersey and Virginia. And President Clinton signed an executive order that will take effect in January giving parity for mental health coverage for some 9 million federal employees.
The insurance industry says the answer isn't mandates. The coverage is there, they say, it's up to employers to decide to provide it. "The employer community is betwixt and between,'' said Richard Coorsh, spokesman for the Health Insurance Association of America. "On the one hand they're eager to continue to provide coverage for their employees. On the other hand they have to deal with health care cost increases which translate into higher premiums. Therefore, adding additional cost can provide an impediment to additional coverage for mental health services."
The report falls short of calling for exact parity with the rest of the health care coverage, but says equal coverage should be "an affordable and effective objective."
"This report underscores the need to continue to strengthen our nation's mental health system and fight the stigma associated with mental illness so all Americans can get the treatment and services they need to live full and productive lives,'' said Tipper Gore, wife of Vice President Al Gore. She has made identification and treatment of mental illness a top priority.