Recently I was asked, “It’s obvious that all of us are touched by mental illness – in ourselves, our families, or people we know. Why don’t we all demand that mental illness be funded for treatment just like biological illness?”
My clients have been speaking to this for decades – why didn’t they seek out treatment, demand treatment coverage from their health insurance company, demand their workplace purchase insurance that covered mental health treatment?
Their comments go in many different directions. First, some barriers expressed in my office by individuals that have opinions (but not enough information) about mental illness:
Mental illness is actually a moral issue: “I was angered that the pastor in church preached for gun control after recent rampage shooting ‘rather than for family values, as the Pope just did, which would have prevented that shooting.’
Mental illness is actually a financial issue: “(I am resentful) that mental health parity law now demands coverage of mental health illnesses ‘because that comes directly out of my profit margin’ to my employees.
Mental illness is actually a religious failing: “(family member) doesn’t need counseling – she needs Jesus!”
Then there are the barriers of ‘scale.’ There isn’t a “we” to demand that mental health treatment be funded. There are small fragmented coalitions or individuals that speak out, but no powerful lobbyists.
Next we have structural legal and profit barriers. Mental health treatment fees paid to service providers were set in 1989 when “managed care” health laws were passed. These fees REMAIN IN PLACE and have not risen due to inflation or competition, from which health insurance law exempted companies in 1947. That means your psychotherapist (counselor, social worker, psychologist, psychiatrist) has not has a raise in salary in twenty-four years. According to the Bureau of Labor and Statistics[i] that $60 per hour fee set in 1989 now has the buying power of $31.86.
And a paper from 2010 [ii], if accurate, cites an important structural legal loophole for insurance companies. Quote:
“In mental health, there is a double layer of administration and profit—after 20% of premium dollars are used for administration and profit, the remaining mental health funds are transferred to a MBHC [managed behavioral health care] entity. Some of these are independent entities, and some are subsidiaries of their insurance company. All of the funds transferred to the MBHC are recorded as a medical expense, but in reality, these are profit-making entities with large administrative expenses. The administration and profit of MBHC entities is hidden from the publicly reported medical loss ratios.”
It appears that significant money intended for mental health treatment is ‘siphoned off’ to administrative costs and to profit the insurance company.
There are other barriers. Again, quoting my clients:
Social norms: In many urban and rural neighborhoods, mental illness is a social norm: “we didn’t think much of it, all the husbands in the neighborhood beat their wives and kids”.
Shame: “I was ashamed of my thoughts, feelings, behaviors about being mentally ill. It was just so humiliating to be unable to get out of bed and function like everyone else.”
Fear: “Everyone in the neighborhood feared his father, who was alternately nice and then really enraged. No one would deal with him”
Political ideologies: “I have the right to (own unlimited firearms, raise my children as I will, treat my neighbors with disdain).”
Social ideologies: “Those addicted to drugs should be locked into prisons for extended periods of time.”
Psychophobia: A term I have coined to express the blanket rejection of the psychological, the inner life, the observable facts of repeated behavior-emotion-cognition and their consequences. When a President of the United States faced a crisis regarding infidelity, whom did he call? Tony Robbins, an untrained, unlicensed motivational speaker. In wide circles outside of urban and rural American cities, it’s easy to find a man like I did in Montana. He asked me, ‘what do you do for a living?’ “Psychotherapy,” I answered. His face froze in a rage as he barked out the question-accusation, “… PSYCHO????……” I changed the topic to how the trout fishing was that day for him on the Yellowstone River.
What can be done? These barriers can be addressed, through public health education and political change, one at a time.
A simple law could be passed with these effects:
- cut the extra-profitability away from managed care institutions and push those funds to the treatment of the insured
- allow the insured citizen to hire any licensed behavioral health professional as their psychotherapist (i.e. to go “out of their panel” of contracted providers), by combining their insurance coverage and their own financial resources
- provide for a vast educational effort, not unlike for obesity or smoking or rape other proven tragic health problems in America, to bring the American public current, empirical information about mental health, its forms and its treatments
- prohibit price fixing and collusion among health insurance companies in setting fees for mental health treatment
- mandate that ‘up front deductibles’ (where the insured has to pay a lump sum first before their coverage for therapy begins) be declared illegal
Carlton F. “Perk” Clark is a licensed clinical social worker, practicing psychotherapy and organizational development in Tucson since 1975. Feedback: perkclark@yahoo.com
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- [i] Bureau of Labor and Statistics, retrieved August 13, 2013 from http://www.bls.gov/data/inflation_calculator.htm
- [ii] Miller, I. (2010) Underfunding Mental Health Services—Disparity 2.0: Isn’t It Time for Real Reform? Retrieved August 12, 2013, from www.ivanjmiller.com/disparity_action.html.