MENTAL HEALTH: Satcher Report Ignites National Debate
Monday's release of the surgeon general's report on mental health instigated a nationwide discussion on the issues surrounding the topic. The two main goals of the report, Surgeon General David Satcher told PBS's "NewsHour," are to lessen the stigma of mental health and to increase access to help. He also emphasized that the report is firmly rooted in science. "I think there's been a virtual revolution in the science of mental illness over the last 25 years, and using that science, we hope to make the point that mental illnesses are real. They have real physical, chemical bases. There's no longer justification for distinguishing between mental and physical illnesses" (PBS "NewsHour", 12/13).
Tipper Gore, a longtime advocate for the mentally ill, said that it was the nation's responsibility to eliminate mental illness' stigma, adding, "No law or government program is going to do that for us." Al Gore, in a campaign visit to a steel mill in Ohio, addressed the issue as well, asking those who knew a relative touched by mental illness to raise their hands. When only a few did, he said that he knew some people were probably ashamed to speak up, and added, "We need to get past that." Advocates for the mentally ill hope to use the report in getting equal coverage for mental illness, or "parity." John Bryan, who runs Florida's mental health system, said, "In many state legislatures, it's a very hard sell. Coming from the surgeon general, it carries some weight" (Meckler, Associated Press, 12/14). Rep. Marge Roukema (R-NJ), a sponsor of a mental health parity bill, said that the report, which states that parity is an affordable objective, "documents the cost-effectiveness of early treatment to help people. This is no longer opinion -- this is established fact."
Who Should Pay?
But some say that the parity bill would "open employers to large and unpredictable costs." Carmella Bocchino, vice president for medical affairs of the American Association of Health Plans, acknowledged the legitimacy of the report's findings, but noted that finding a way to pay for mental health coverage would take a nation engaged in an "honest debate." She added, "We've seen estimates that mental health parity would require cost increases of 1% to 5%. So there will be trade-offs here. Do we give up other parts of the benefits package, or are we looking to rising health care costs?" (Kaufman, Washington Post, 12/14). An editorial in the Washington Post addresses the financial issues, stating that the "lack of confidence [of mental illness's validity] is reflected in insurance policies that often impose tighter limits on payment for mental than for physical illness. Money thus becomes an issue..." It goes on to say that mental health is one more addition to the "list of structural inadequacies in the health care system," and that while mental health needs to be addressed, "cost is the central problem in meeting the need ... the cost does need to be faced, and not obscured" (12/14). An editorial in the Boston Globe asserts that "early intervention can head off more serious problems and higher costs later," and that failure to treat mental illness is a "cruel and wasteful practice of false economy" (12/14).
Managed Care's Role
But as discussions over the future of mental health care coverage go on, the present state of managed care and mental health is under scrutiny. A 1996 study found that of $32 billion spent on mental health care for those with private insurance, only $18 billion came from insurers, alluding to the high out-of-pocket costs for covered patients. Although 53% of Americans have at least some parity in their health benefits, Laurie Flynn, executive director of the National Alliance for the Mentally Ill, called it an "empty victory." She added, "The money dedicated to mental health is declining." The surgeon general's report tackles the controversial area of managed care, and says any kind of conclusion would be premature, as "research is just beginning on how managed-care cost-reduction techniques affect access and quality." Some reports indicate that managed care has increased access, albeit outpatient access, but others seem to say that plans that limit or push non-specialists to treat mental illness may actually increase disability and contribute to reduced work productivity. Satcher, in the report, said, "There is no reason to think managed care lowers the quality of mental health care," but added that "some may think we are giving managed care more credit than it deserves."
A Looming Wave of Mental Illness
Mental health will stay in the forefront of national debate as the baby boomer generation moves into an age range where mental illnesses increase and become more costly. The report says, "Disability due to mental illness over 65 will become a major public health hazard in the near future due to demographic changes" (Elias, USA Today, 12/14). Twenty percent of Americans 55 and older experience mental disorders that are not part of the normal aging process, and with 75 million baby boomers, the proportion of people likely to have disorders like depression, substance abuse, Alzheimer's, anxiety disorders and late-onset schizophrenia will increase. Studies also indicate that baby boomers are more likely to fall into alcohol or substance abuse than the generations that preceded them, due to boomers' history of greater alcohol and drug consumption than their predecessors. The report warns that this coming tide of aging individuals will put stress on the "current system of mental health care delivery" (Healy/Marquis, Los Angeles Times, 12/14).