False par­ity be­tween men­tal and phys­i­cal health care

The Washington Times Daily - - Nation - By Richard E. Vatz

For decades, the men­tal health fields have been fight­ing for the gold stan­dard in cov­er­age of men­tal dis­or­ders: par­ity with phys­i­cal ill­nesses. The ex­ten­sion of fed­eral pol­icy was an­nounced by Sec­re­tary of Health and Hu­man Ser­vices Kath­leen Se­be­lius along with decades-long sup­porter Ros­alynn Carter ear­lier this month. The new rules com­bine the in­tent of the 2008 Men­tal Health Par­ity and Ad­dic­tion Eq­uity Act with Oba­macare reg­u­la­tions to yield vir­tu­ally un­lim­ited men­tal health care to any­one di­ag­nosed with a psy­chi­atric dis­or­der. If men­tal health providers di­ag­nose men­tal ill­ness, co-pay­ments, de­ductibles and life­long cov­er­age will be com­pa­ra­ble to those af­forded pa­tients with di­ag­nosed gen­uine med­i­cal ill­nesses.

The ar­gu­ments against such ex­panded cov­er­age have al­ways fo­cused on its in­va­lid­ity, un­in­tended so­cial con­se­quences and the costs of men­tal ill­ness treat­ment, both drug and talk ther­apy.

Through­out the past half-cen­tury, there has been con­sid­er­able de­bate over whether most men­tal dis­or­ders are ac­tu­ally phys­i­cal, neu­ro­log­i­cal ill­nesses.

While many crit­ics of equat­ing men­tal ill­ness with phys­i­cal ill­ness were un­will­ing to con­cede that even the most ex­treme men­tal states and be­hav­iors — such as some schizophre­nias — were au­then­tic med­i­cal ill­nesses, a sub­stan­tial por­tion of the gen­eral pub­lic in­fers that ev­ery­day prob­lems have the same likely neu­ro­chem­i­cal link as “se­vere men­tal ill­ness.”

In ad­di­tion, many peo­ple think that psy­cho­log­i­cal prob­lems of chil­dren, whether or not they are real phys­i­cal dis­eases, are suf­fi­ciently poignant to jus­tify be­ing termed “ill­nesses” which de­serve third-party pay­ments. The ex­po­nen­tial in­creases of di­ag­noses of At­ten­tion-Deficit Hy­per­ac­tiv­ity Dis­or­der over the past sev­eral decades have thus en­gen­dered lim­ited crit­i­cism.

While a few se­ri­ous psy­chi­atricmed­i­cal dis­or­ders (they are not called “dis­eases” in psy­chi­a­try’s di­ag­nos­tic man­ual) such as ma­jor de­pres­sion may war­rant life­long cov­er­age, many, if not most, of the hun­dreds of di­ag­noses therein surely do not. Merely dis­turbed “pa­tients” may be di­ag­nosed as hav­ing “ad­just­ment dis­or­der,” “so­cial pho­bias” or many of the other catch-all di­ag­noses. Pro­vid­ing them lengthy and ex­pen­sive at­ten­tion and treat­ment may be a lot of things, but it is not nec­es­sary med­i­cal sup­port.

The great ma­jor­ity of prob­lems at­tended to by men­tal health pro­fes­sion­als have no es­tab­lished chem­i­cal-neu­ro­log­i­cal cause and surely con­sti­tute the “prob­lems in liv­ing” that are ill­ness only me­taphor­i­cally. Be­cause so many of the wor­ried well ex­ist with­out any brain chem­istry es­tab­lished as the cause, we get es­ti­mates of a 500 per­cent in­crease in num­bers of men­tally ill dur­ing the past five decades. There is even a claim in a study spon­sored by the Na­tional In­sti­tute of Men­tal Health that more than half of the pub­lic will suf­fer a men­tal dis­or­der in their life­time.

The un­in­tended con­se­quences of such pro­lif­er­a­tion of men­tal-dis­or­der di­ag­noses also in­clude the over­all di­min­ish­ing of as­sumed in­di­vid­ual re­spon­si­bil­ity for peo­ple’s prob­lems and at­trib­uted re­spon­si­bil­ity for bad or il­le­gal be­hav­ior, as rep­re­sented by the in­san­ity plea in the crim­i­nal jus­tice sys­tem.

Less­ened ac­count­abil­ity for un­to­ward be­hav­ior pro­vides less in­cen­tive for chang­ing such be­hav­ior, as well as the in­fer­ence that one’s mood and ac­tions can­not be con­trolled with­out phar­ma­co­log­i­cal or coun­sel­ing in­ter­ven­tions.

Med­i­cal cov­er­age for those who drink too much or take too many drugs is an ex­am­ple of “treat­ing” be­hav­ior that is clearly vo­li­tional and vol­un­tary, es­pe­cially at its in­cep­tion, and re­quires willpower, not med­i­cal in­ter­ven­tion. To al­low adults to as­sume that so­ci­ety will take care of one’s “al­co­holism” or drug abuse in­cen­tivizes per­pet­u­a­tion of the de­struc­tive be­hav­iors.

The fi­nan­cial con­se­quences of gen­uine par­ity can­not be pre­cisely known. If, how­ever, the stigma of re­ceiv­ing ex­ten­sive men­tal health care is sig­nif­i­cantly re­duced and un­lim­ited du­ra­tion of treat­ment is al­lowed across the board, costs will in­evitably sky­rocket.

Equat­ing phys­i­cal ill­ness with men­tal ill­ness has the ap­pear­ance of eq­uity, but it is an equa­tion based on a false premise that they are iden­ti­cal. Fur­ther­more, it is de­struc­tive cul­tur­ally, mak­ing us, as one writer terms it, a “na­tion of vic­tims.”

We can­not af­ford the so­cial or lit­eral cost of this cul­tural change.


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