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Mental Health May Be Part of Reform, Tipper Gore Says


WASHINGTON — The Clinton Administration is likely to place insurance coverage for mental disorders on an equal footing with coverage for physical ailments, a move that could dramatically expand the availability of treatment for millions of Americans suffering from various forms of mental illness, Tipper Gore said Wednesday.

Although Mrs. Gore--wife of the vice president and mental health adviser to the White House health care reform task force--emphasized that no decision has been made, she said task force members who will draft the final health care reform proposals are being urged by a wide array of experts to make the change, a move she avidly supports.

"Why should a woman with diabetes who needs insulin have it covered by insurance, whereas a woman with manic-depressive illness who needs lithium not be covered in the same way when both diseases can be managed and controlled?" Mrs. Gore asked in an interview with The Times.

"What we are arguing for is parity with physical illness," she said. "It's a question of fairness."

At any time, as many as 18% of Americans, including 14 million children, suffer from a diagnosable mental disorder, the American Psychological Assn. asserts, and as many as one in five Americans will experience at least one episode of major depression during their lifetimes. Moreover, mental health treatment costs about $147 billion a year--a sizable portion of the nation's $700-billion annual health care bill.

Now, many insurance plans offer no mental health coverage at all or coverage that is substantially less than that for physical problems. Plans that do provide coverage typically will pay for the full cost of hospitalization but with stays often limited to about 30 days. They also typically severely limit outpatient services, such as doctor visits, sometimes to as few as 20 a year. And they often require extremely high co-payments for outpatient services, which can discourage individuals from seeking sufficient help or from continuing treatment.

Mrs. Gore, who earned her undergraduate and master's degrees in psychology, long has been active in mental health issues, particularly those involving children and the homeless. She chairs Tennessee Voices for Children, an organization that promotes services for youngsters with serious behavioral, emotional, substance abuse or other mental health problems. She also is co-chairwoman of the Child Mental Health Interest Group, a group established by the National Mental Health Assn.

In drafting a policy for universal health insurance coverage, the Administration almost certainly will include mental health services as part of its core benefit package, Mrs. Gore said.

"I think it's very important that people who need some kind of mental health help get it," Mrs. Gore said. "They wouldn't sit in bed with a 104-degree fever and not get treated. They should think about mental health disorders in the same way."

Mrs. Gore and others said this approach has received even greater impetus in recent years as a result of research showing that some serious mental disorders--such as schizophrenia and manic-depressive illness--are biochemical in nature and often can be treated with drugs.

"Most mental illnesses are controllable and treatable," Mrs. Gore said. "We have seen this clearly." Years ago, a person diagnosed with schizophrenia "was sentenced to be in a state hospital for the rest of his life," she said. "That has changed dramatically."

Today, such individuals have been treated, "are functioning in jobs," and "have made remarkable strides," she said.

Nevertheless, neither the health care system nor public awareness has caught up with that progress, Mrs. Gore said. She said she agrees with mental health experts who have complained for years that treatment for mental disorders has been the "stepchild" of health benefits, subject to many more restrictions and limits than other illnesses.

"I'd go as far as to say 'orphan,' rather than stepchild," Mrs. Gore said. "A stepchild is still part of a family, with some care. Many people (who need mental health services) are left out in the cold."

Although no decisions have been made about the extent of mental health coverage under the reform proposals, Mrs. Gore and others predicted that mental health treatment would not be given short shrift.

The task force "will have to consider flexibility and cost containment measures, but they will be applied equally," she said. "If you have to have some kind of limited service, the limitations won't only affect mental health. Mental health will not be singled out. The limitations will be applied across the board.

"We want to increase coverage for people and cover mental health in a way it's never been covered before."

Mental health benefits also are likely to be restructured to place a greater emphasis on a "community-based continuum of care," including outpatient care, partial hospitalization and other services, she said.

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