The Great Divide–Bridging The Gap Between Medical and Psychiatric Care

A couple of articles in my local rag caught my attention (The Philadelphia Inquirer . . . and yes, I still read the paper version of it) and has brought me back to the writing table.  Thursday’s article about entitled “A global mental health concern” spoke the growing realization that mental health issues are becoming . . . well . . . more of an issue.  Or, at least we are starting to pay attention to it.  Clinical depression (Major Depression in this country’s parlance) was identified as the second most common cause of disability, with the highest rates of depression hitting men and women of working age.  Only lower respiratory infection (eg, pneumonia) caused more disability.  In some areas of the world (Central America, and Central and Southeast Asia) depression ranked as the top cause of disability.  In my own work with patients in this area, I see every day the ravages of depression.  The reduced productivity or the inability to work.  The effect that it has on spouses and children.  Even with progress on the social acceptance of mental health issues, it continues to be a source of considerable shame for people.  This leads to needless delay in treatment and a reluctance to accept all available treatments for the ailment.

But we are making progress, no?  This leads me to article number two of the week.  Saturdays paper brought the (misleading) article entitled “Mental, physical illnesses must get same coverage”.  WOW . . . isn’t that GREAT!!!  We have FINALLY made it to a spot where people can get the care that they need.  Or . . . have we.

On first glance it would appear so.  Scratch the surface and you find differently.  The mental health parity law was first signed into law in 2008 by George W. Bush and covered only large group plans.  The Affordable Care Act now extends the expectation of parity to small and individual health care plans.  Sounds great.  But a little publicized fact remains that parity mental and physical health coverage is only required . . . IF THE HEALTH CARE PLAN HAS MENTAL HEALTH COVERAGE.  Yes, the ultimate solution for some of these plans is just to not provide mental health care. At all.  Parity problem solved.  In addition, the expectation of mental health parity does not apply to managed care plans through Medicaid or the State Children’s Health Insurance Program (SCHIP), two programs that are vitally important to many of our most vulnerable neighbors.

So, we have the identification of Major Depression as a national and global issue.  We have the scientific means to intervene and help people feel better.  But our society continues to feel it is ok to not cover the costs of treatment for people who are potentially vulnerable and unable to effectively speak up for themselves. On some level, most of us will start making excuses about this.  Worries about how much this is going to cost us . . . and will including mental health care make something more expensive for ME.  Are my taxes going to go up . . . and how do we know when people are REALLY depressed?  Maybe they are just being lazy!

It is clear from all investigations that Major Depression is a huge social concern and a significant socioeconomic drain on our economy.  It is clear that the treatments that are available are safe and effective, especially when delivered in a timely fashion.  Diagnosing Major Depression is a straight forward process.  Quality treatment centers can provide effective treatment that will allow patients to get their lives back on track.  We as a society would NEVER allow insurance companies to institute across-the-board denial of coverage for pneumonia, diverticulitis, heart failure, or strep throat. How can we sit back and allow mental health treatment to be an optional component of our ongoing revision of health care in this country.

Failure to address the mental health care needs of our community leads to needless pain and disability.  It leads to families that experience social and financial catastrophe.  And it can lead to tragedies such as that seen in Colorado and Connecticut.  I am sure that few will rush to their computers to email their Senators and Representatives.  But keep this in mind as you come in contact with your family, friends and coworkers who deal with mental health issues . . .  what if THEY could not get the care they need?  What if their insurance denied them the treatments that could bring them back to health?  Is it ok to sit back and let people suffer because of a loophole in the laws that are passed?

I think not.

–Dan Hartman, MD