Project 2 Paper

Lack of Mental Health Care
Coverage and Its Effects

Mental illness is a prominent issue in current American society, and the affects mental illness has on both the individual and society as a whole are staggering. "One in four adults – approximately 57.7 million Americans – experience a mental health disorder in a given year" ("Mental Illness: Facts and Numbers"). The high prevalence of mental illness is compounded by limited access to insurance coverage for mental health care, despite the proven efficacy of proper treatment. "Fewer than one third of adults and half of children with a diagnosable disorder receive any mental health services in a given year" ("Mental Illness: Facts and Number). Additionally, the segregated treatment of the body and the mind complicates matters, for there is "substantial evidence for an interaction between illnesses of the body and the mind" (Kathol and Gatteau xv). In order to reduce the pervasiveness and ill effects of mental illness, health insurance companies must provide increased coverage for mental health services and more collective care of the body and mind.

"Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning" ("Mental Illness"). They are "medical conditions that often result in a diminished capacity for coping with the ordinary demands of life" ("Mental Illness"), just as somatic illnesses like diabetes and fibromyalgia do. The body and mind work in tandem. Somatic illnesses are worsened by mental illnesses just as mental illnesses are worsened by somatic illnesses. For both somatic and mental illnesses, it is vital that the care of the body be coordinated with the care of the mind. Several reliable studies have found that separating treatment of body and mind can cause "pitfalls of separation in terms of persistent distress from ineffective disease treatment, high costs, illness complications, and lost productivity" (Kathol and Gatteau xv)

Commonly, people are unable to receive treatment because of strict limitations on the coverage of mental-health services or the lack of coverage all together. Even if a person does have coverage, he or she is typically responsible for paying an additional and often expensive co-pay. Typically, "health insurance companies, health maintenance organizations (HMOs), and other health insurers limit the number of (therapy) sessions that they will underwrite to six or less" (Srebalus 302). In order to not exceed the session limit, briefer forms of therapy are employed, which commonly lowers the efficacy and value of the therapy. If a person is uninsured, or the benefits covered by insurance are exceeded, that person must pay for treatment out of pocket. Paying out of pocket can prove to be extremely expensive, and for many, is not an option whatsoever. Needless to say, the expense also discourages many people from seeking treatment.

A pharmacological approach is often used as a treatment option in addition to psychotherapy. When insurance will not cover therapy and the person is unable to afford it, many doctors use only a pharmacological approach. Doctors often due this out of desperation when a person cannot afford or is unwilling to go to therapy, using the rationale that some treatment is better than no treatment. However, treatment with only medicine is certainly not n ideal approach, especially considering the fact that "some psychiatrists estimate that nearly one-third of all people who are treated with drugs are not greatly helped by them" (Srebalus and Brown 303). Additionally, many insurance plans have coverage restrictions on certain types, brands, or quantities of medications, which can often deter a person from taking a medicine even if it is the most effective. Consequently, "millions of Americans are affected by mental illness, yet remain untreated or under treated for their conditions" ("Mental Illness: Facts and Numbers").

When individuals suffering from mental illness are unable to get treatment, they often turn to unhealthy methods in an attempt to feel better. Many people try to self medicate with drugs and alcohol. Some develop extremely poor and ineffective coping mechanisms, such as eating disorders or self-mutilation. Other individuals begin to act inappropriately either out of desperation, because of the emotional pain they are experiencing, or under the influence of their psychosis. For example, a mother may suffocate her children because ‘the voice of God’ told her too, a sexual predator may rape his victim because the traumatic sexual abuse he suffered from as a child, a paranoid schizophrenic may kill his neighbor because he was certain the neighbor was an alien trying to take over his mind, or a person will severe bipolar disorder may become homeless because the severity of his symptoms left him unable to hold a job. It is evident that these inappropriate actions affect all of society, not just the person executing them. "Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives" ("Mental Illness").

Although untreated mental illness cannot be blamed for all societal ills, it clearly plays a significant contributing role. For example, "Twenty four percent of state prisoners and twenty one percent of local jail prisoners have a recent history of a mental health disorder" ("Mental Illness: Facts and Numbers"). Up to seventy five percent of criminals can be diagnosed with antisocial personality disorder. Teenagers with mental health issues are far more likely to drop out of high school than their healthy peers. Additionally, "some people who either do not respond to treatment or fail to get adequate care end up as homeless individuals."(Srebalus and Brown 303). In all these cases, both the people suffering from mental illness and any innocent people they prey on may become victims. Society then must put money into caring for these victims and criminals.

"The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States" ("Mental Illness"). Included in this figure, for example, is funding for jails, homeless shelters, unemployment, and disability. Funding is not only lost on people who are clearly struggling to function and survive, but also on individuals suffering from the difficulties of mental illness while still maintaining a base level of functioning. "It costs employers billions in lost workdays and productivity (The U.S. surgeon general's report on mental health some years ago indicated that the indirect costs of untreated mental-health disorders resulted in a $79 billion annual loss to businesses due to loss of productivity and absenteeism alone)" (Pfeiffer, "Equal Coverage for Mental Illness").

Why then, with all the ill effects proven to be connected to untreated and under treated mental illness, is Congress so hesitant to pass legislation mandating increased coverage of mental health services? Coverage for mental illness should be the same as coverage for somatic illness, or, in other words, there should be parity. The main reason that Congress continues to veto this is because they wrongly assume that parity would increase health care cost. "In actuality analysis indicate(s) that putting mental-health coverage on an equal footing with physical-health coverage would cost employers just 1 percent, or $1.32 per enrollee per month" (Pfeiffer, "Equal Coverage for Mental Illness"). Additional studies "have shown that costs actually declined after parity was introduced" (Pfeiffer, "Equal Coverage for Mental Illness") provided that some form of managed care, or coordination of care, was simultaneously introduced. The costs were lowered even though the number of users increased because the users’ average expenditures lower. These results most likely indicate that people were staying healthier, and therefore did not need costly and extensive emergency treatment. If untreated illnesses deteriorated into a more serious condition, they required greater treatment expenses. Also, by receiving care shortly after the onset of their symptoms, fewer individuals needed to go on disability because their illnesses never reached such an acute stage.

Clearly there are many advantages to individuals and to society if mental health care coverage was increased. The individual would also be able to receive more coordinated, comprehensive care of both the body and the mind, which would greatly increase the efficacy of treatment. Despite the slightly elevated cost of health care, overall expenditures would be reduced because of decreased expenses resulting from the ill-effects of mental illness.