Readers Speak Out

On Mental Health Parity

October 27, 2008

The column by Richard E. Vatz and Jeffrey A. Schaler on the mental health insurance parity law recently passed by Congress contained so many mischaracterizations that it's hard to know where to begin to correct them ("'Parity' through the back door," Commentary, Oct. 23).

First, the law is not "government-mandated coverage." It applies only if group health plans offer mental health coverage. Under the new law, if they do, they cannot impose separate, unequal limits on coverage for mental health care relative to other illnesses.

Second, parity was not quietly slipped into the financial rescue legislation. It was publicly mentioned during the congressional debate.

Indeed, different parity bills already had been approved by the Senate and the House of Representatives.

Numerous studies, including a cost estimate from the Congressional Budget Office, demonstrate that mental health parity is affordable for employers and health plans.

That is why the U.S. Chamber of Commerce and the National Association of Manufacturers supported the parity bill.

Parity will help people who live with mental illnesses get the help they need.

And the column's statement that "there is no way to accurately confirm or disconfirm 'mental illness'" is simply not true.

Scientifically validated diagnostic criteria exist for illnesses such as schizophrenia, bipolar disorder and major depression.

And stigma is not, as the authors suggest, "a marvelous negative reinforcer for undesired behavior."

The U.S. surgeon general has called it "bias," "distrust" and "stereotyping" that in its "most overt and egregious form ... results in outright discrimination and abuse. More tragically, it deprives people of their dignity."

Michael Fitzpatrick, Arlington, Va.

The writer is executive director of the National Alliance on Mental Illness.

Richard E. Vatz and Jeffrey A. Schaler look at psychiatry through the prism of the 19th century. Modern medicine and research consider the brain an organ with anatomical structures between which impulses are transmitted.

Many psychiatric disorders, such as my child's obsessive compulsive disorder, are known to be a malfunction involving these connections.

My family pays substantial premiums for our medical insurance. Yet the insurance coverage pays less to deal with my child's illness than it would if my child had epilepsy, another malfunction of signal transmissions in the brain.

And to suggest that the stigmatization of a person afflicted with a psychiatric disorder is a "marvelous" deterrent for "undesired behavior" is reprehensible.

I have seen firsthand the suffering of a young person, and it is heartbreaking.

I correct myself: Mr. Vatz and Mr. Schaler aren't operating in the 19th century; they are lost in the Dark Ages.

Patty Nicholls, Baltimore

The column by Richard E. Vatz and Jeffrey A. Schaler was judgmental, inaccurate and illogical.

I do agree that defining "mental illness" is difficult, and perhaps we shouldn't even try to do so. But most of what we define as mental illness is the result of dysfunction of hormones and brain chemicals. That is why medical treatments work so well.

What we now call "mental illness" not only causes the victim to suffer but also creates family strife, disability and societal expense.

Untreated, it increases the risk and severity of other diseases. But as with most preventive measures, early and effective management will be cost-effective.

I know. I am a doctor, and I suffer from depression.

With treatment, I have a successful practice, well-adjusted children and great health.

But every day, I see unnecessary suffering by those who believe they should just "tough it out."

Dr. Colleen M. Fitzpatrick, Timonium

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