Mental Health Care: It's Needed and It WorksProfs. Richard...


February 19, 1994

Mental Health Care: It's Needed and It Works

Profs. Richard E. Vatz and Lee E. Weinberg wrote an article entitled ''Making Maryland 'the Therapeutic State' '' in your paper Feb. 13. It tries to address a legitimate concern over health care cost and the co-payment price-sensitive portion of mental health parity bill soon to be voted on in Maryland General Assembly.

Dr. Vatz, a professor of rhetoric at Towson State University, and Dr. Weinberg, professor of public and international affairs at the University of Pittsburgh, use old rhetoric, outdated knowledge, discriminatory mentality and bigotry to advance their argument.

If opponents of mental health parity reform cannot muster better suited individuals than professors of rhetoric and international affairs from the vast pool of scientists, health care analysts and psychiatrists to advance their argument, they are in a pathetic state of affairs.

Drs. Vatz and Weinberg should have applied the first cardinal rule of an academician, which is to stay abreast of current knowledge and information in the analysis of a given problem.

Unfortunately, they are applying outdated theories regarding mental illness. Their article practically denies its existence and hardly admits to what they condescendingly keep referring to, in an old statement by Thomas Szasz, as ''problems in living.'' They obviously have not familiarized themselves with the

medical literature for the past 40 years.

Do they know that 10 percent (tens of thousands) of depressed individuals eventually commit suicide?

Do they really think committing suicide is not caused by a disorder of the brain? Do they care that the majority of those individuals could have been helped to become productive citizens?

In 1930 in Germany, the Nazis wanted to reduce health care cost by denying it to the handicapped and mentally ill. They proceeded to forced sterilizations and subsequently to exterminations of the handicapped and mentally ill as a way to relieve the burden on the German economy.

There are thousands of diseases for which medical science knows neither the cause nor the perfect treatment.

Alzheimer's, a very prevalent disease among the elderly, is treated with a variety of drugs which are not known as a cure. No one disputes that Alzheimer's is a disorder of the brain despite the fact that that there is neither the specific test nor a specific treatment for this disease.

Despite these uncertainties, health insurance companies do pay for all these treatment modalities. The reason is that diagnoses are based first and foremost on symptoms and not on a clear chemical test.

Maybe medical science will have more advanced tests in the future. Using Drs. Vatz and Weinberg's logic, no one should have been treated 50 years ago because no specific test was available.

No one in the scientific community disputes the fact that the brain is just another organ in the body susceptible to all of the pathology and diseases inherited or acquired, like the heart, lung and kidney. Moreover, the brain is the most important and the most complex organ in the body.

The brain controls all of our body functions and especially our behavior. Why then would one assume that the brain would not be susceptible to the physiological and biochemical aberrations that would then manifest themselves in a change in behavior?

Three independent studies have shown that the cost of mental illness and substance abuse as a percent of total health care cost has not changed for the past 20 years. Moreover, the cost in dollars and the human cost to society for not treating mental illness far exceed the cost of treatment. This is especially significant when we know that we can treat 80 percent of the mentally ill.

If Drs. Vatz and Weinberg are concerned about health care cost, there are less discriminatory and bigoted methods of cost containment applicable to all health problems.

Some of these are included in the Maryland mental health parity bill, such as office visits with co-payments that make expenditure by the patient price-elastic, and the use of managed care when appropriate with strict medical necessity and utilization review applied.

In this fair way, health insurance would pay for needed care, not for the category one may call ''improving the quality of life.''

The Maryland General Assembly is on the right track to end discrimination toward the mentally ill. Legislators last year took a giant step in this direction.

The people of Maryland should be proud of their legislators when this year both the insurance companies and mental health advocates have agreed on a workable bill that ends discrimination toward persons with mental illness.

Maryland will become the first state in the country to outlaw discrimination toward the mentally ill in health insurance coverage.

Adil E. Shamoo


The writer is professor of biological chemistry at the University of Maryland School of Medicine.

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