Mental Health Needs Are Going Begging

STEVEN S. SHARFSTEIN

March 18, 1992|By STEVEN S. SHARFSTEIN

Access to quality mental health services has reached crisis proportions throughout the United States. In addition to the 34 million Americans with no health insurance whatsoever, some 30 million people have no mental-health insurance, despite the fact that almost one-third of American adults will suffer from a mental or substance abuse disorder at some time in their lives.

Restrictions on treatment for mental disorders within insurance plans disenfranchise these Americans from access to the private-care system which, in the last decade, has grown in scope and quality.

Recent erosion of mental-health benefits already established in health insurance plans has exacerbated the problem.

Today, it is rare for any insured American to have more than the most short-term benefits, paying for no more than one serious episode of psychiatric illness in a year. Men and women suffering from treatable disorders such as depression, severe anxiety and addiction are going untreated at great economic and social cost to our society.

The crisis in health-care coverage is a continuing example of the stigma against the mentally ill, despite impressive clinical and cost-effective gains in treatment.

Cutbacks in state programs in combination with lack of access to the private sector have created, after the AIDS epidemic, the single most critical public health problem in America today: the wandering, homeless, mentally ill person. One in three of the homeless men and women who live in the streets of our cities is suffering from some form of mental illness.

In Maryland, many individuals and families have experienced the financial calamity of a mental illness worsened by insurance coverage cutbacks. At Sheppard Pratt, which is a private, not-for-profit hospital, three of every 10 referrals have no mental-illness insurance coverage or their insurance coverage has been exhausted in a previous episode of illness -- double the figure of just two years ago. Too many of the patients who come into our hospital must leave ''quicker and sicker."

The time to put together universal coverage is now, and this coverage must include full parity for the treatment of mental illness. Whether a single-payor plan, a pay-or-play employer-based plan or another variant, what is critical is parity, non-discriminatory coverage for the treatment of mental illness.

The mentally ill deserve the best of modern psychiatric care. Although this costs money, the returns to the family and to the overall health and economic productivity of society make the investment extremely worthwhile.

Steven S. Sharfstein, M.D., is president, CEO and medical director at Sheppard and Enoch Pratt Hospital and Health System.

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