Opinion — 21 August 2012

We take our safety for granted when we go out in public. We do not think about all the people we encounter and the personal issues they may be battling. The shootings at the Sikh temple in Wisconsin and at the movie theater during the midnight showing of “The Dark Knight Rises” in Aurora, Colo., remind us that mental illness is not only a personal problem, but, untreated, can cost a nation more than just insurance premiums; it costs lives and causes trauma. The shooter in Aurora, James Holmes, was battling demons of his own.

Mental health in the United States historically has been placed on the back burner. It has become obvious that mental health is a health care issue that we can no longer overlook. Today, mental illness is the leading cause of disability in the U.S. Yet the United States as a whole pays significantly less toward coverage of mental health services as compared to other illnesses like diabetes, asthma or hypertension.

According to a recent report by the Substance Abuse and Mental Health Services Administration, mental illness affected one in five adults in the United States in 2010, from mild anxiety to more severe mental illnesses such as schizophrenia. This means most of us know someone who is affected by mental illness, or are affected by it ourselves.

Federal legislation enacted in 2008, known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, took effect in 2010. It requires that insurance companies that offer mental health services cover them like other health conditions. Insurance companies can no longer practice unequal health coverage, meaning they cannot place an annual or lifetime cap on the number of treatments a person seeks for their condition or place financial limits on mental health coverage that would not be placed on physical illnesses. This allows individuals who have mental health and/or substance abuse disorders to seek the critical care they need.

The Wellstone-Domenici legislation also offers the opportunity for those who need substance abuse assistance to get this service covered by their insurance, if the insurance company covers mental health services. The substance use disorder services in this act, such as drug treatment and counseling, are a positive benefit. Studies on the occurrence of mental illness in violent crimes have found that people with a mental illness alone are more likely to be victims of a violent crime rather than actually commit the violent crimes. However, those with a mental illness who also suffer from a substance use disorder are more likely to commit violent crimes compared to those with mental illness alone and other non-mentally ill members of society. With the substance use disorder services, individuals will be able to seek the critical help they need and also help communities prevent violent crime.

The Wellstone-Domenici Mental Health Parity and Addiction Equity Act is a start in the right direction for insurance coverage of mental health services. It is far from ideal, though. It falls short in that it only applies to large companies with 50 or more employees who have insurances that cover mental health services. The plan does not cover small-business insurance plans or private insurance at this time. This is where improvement is needed. With the new Patient Protection and Affordable Care Act passed by Congress and signed into law in 2010, more people will be covered by insurance and they, too, are going to need mental health parity. We as a society need to push for mental health to be treated by insurance companies like other physical illnesses. Mental illness can be just as debilitating as chronic illnesses and mental illness can even intensify chronic illnesses if not properly treated.

We, as a nation, can no longer overlook mental health and substance use disorder coverage in insurance policies. We need to accept that mental illness can be just as bad or worse than a physical illness.

We have seen what mental illness and substance use disorders can do, and how it affects not only the person who is suffering but also the communities we live in, as with the shooting in Colorado. The mind is a powerful machine and just like our bodies it, too, needs to be maintained and cared for or it can and will destroy us.

Vogel is a social worker and graduate student at San Diego State University.

As first appeared in UT SanDiego.com


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