The vast majority of Americans are unaware of most of what is included in the Senate and House health care reform bills as they head for reconciliation in the House-Senate Conference. They will be in for a big surprise concerning parity mental health care coverage, covering mental problems comparably to physical problems. In addition, the arguments supporting the changes, rarely made public in order to avoid rigorous debate, have revealed the shifting grounds supporting parity.
Health and Human Services Secretary Kathleen Sebelius spoke on Dec. 16 to a friendly crowd of health care providers and others at Sheppard Pratt Health System near Baltimore, a location for a broad array of psychiatric services, concerning mental health coverage, and, according to reports, she defended the expansion of such coverage with all of the familiar shibboleths.
She argued, consistent with the administration’s claim that expanding health care in general to 30 million or more citizens would actually save us money, that the vastly increased mental health parity program would additionally, as the Baltimore Sun reported her message, “improve care for millions of Americans who do not get all the mental health services they need.”
In the speech, Ms. Sebelius said, “One in 5 Americans will have a mental health illness this year and almost half will have a mental illness in their lifetimes. Yet 10 million people didn’t get the mental health care they needed last year, and 20 million didn’t get substance abuse services.”
Ms. Sebelius proclaimed her own false analogy of mental health to physical health by saying, “If 10 [million] or 20 million Americans were walking around bleeding, we’d have alarm bells going off.”
But if mental heath professions’ own estimates of the current number of people who are mentally ill are correct, Ms. Sebelius is way off in her calculations. As Mark Twain quipped, “There are lies, damned lies and statistics.”
The American Psychiatric Association (APA) claims that more than 50 percent of Americans are mentally ill in their lifetime - and recent APA studies dwarf that statistic. Moreover, the problems that qualify as “mental disorders,” all those listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), are virtually without limit.
Significantly, the new coverage of mental illness covers a vast array of the “worried well,” who have no neurological or mental disorders but simply have problems in living. Support for mental health parity in the new health reform bills relies on the public’s false inference that the prototypical mental disorder is dementia or some other organically based brain disease, which constitute only a tiny percentage and atypical sampling of the hundreds of “mental disorders” listed in DSM-IV.
Typically, psychiatrists label those unhappy people they concede have no physical illness as having “social anxiety disorder” or some other equally benign “disorder.” Such people can be in costly, insurance-covered therapy indefinitely. As one psychologist told us, “Anyone who comes in with any problem can be diagnosed as having ‘adjustment disorder.’ ” (e.g., “with anxiety,” DSM-IV Code 309.24).
There are many such diagnoses of easily applicable disorders, including “antisocial personality disorder” (DSM-IV Code 301.7), “avoidant personality disorder” (DSM-IV Code 301.82), and others vague enough to be applied to almost anyone. This is one of the reasons that the American Psychiatric Association claims that in a lifetime far more than a majority of citizens will suffer from a mental disorder, and the estimates are increasing.
In the December 2008 APA’s Archives of General Psychiatry, there is a report that “almost half of college-aged individuals had a psychiatric disorder in the past year [emphasis added],” and this includes heavy drinking, categorized as “alcohol use disorder” (DSM-IV Code 305.00).
When everyone is sick, what is normal? “What is healthy?”
On one strategy to deal with these issues, perhaps Ms. Sebelius and mental health skeptics can agree: It is high time to let a national debate begin - before mental health parity becomes part of universal national health care insurance.
Richard E. Vatz, a professor at Towson University, is associate psychology editor of USA Today Magazine. Jeffrey A. Schaler, a professor at American University, is executive editor of Current Psychology and author of “Addiction Is a Choice” (Open Court Publishing Co., 1999).