False parity between mental and physical health care
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.