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Advocates Hail New Respect for Mental Health Care


It wasn't so much that President Clinton said mental-health services would be included as a basic benefit in his health-care reform plan.

It was Congress' reaction.

On both sides of the aisle, lawmakers rose and cheered the concept of equating illnesses of the brain with illnesses that occur elsewhere in the body.

"For those of us in mental health it was a highlight of 20 years of work," said Keith Dixon, chief executive officer of Vista Health Plans, a managed mental-health care company based in San Diego.

Dr. Bernie Arons, a Washington psychiatrist who has served in federal government and chaired Clinton's subcommittee on mental health, was equally astonished.

"I couldn't believe the spontaneous response. When the (plan) hits Congress, it will be very tough for someone to get on the floor and oppose this," he predicted.

Mental disorders have been traditionally steeped with shame and stigma, while those who suffered from them were seen as crazy or weak. And, despite new research showing many mental illnesses are biologically based, opinion polls show large numbers of individuals still do not believe such disorders are true illnesses.

By including mental health prominently in his health plan, advocates say, the President has done much to advance the understanding of these disorders. Some even exhort that the plan is the best that can be achieved, given cost restraints facing the President.

But others, while praising the President's efforts, say they are disappointed with some shortcomings in the plan.

"What I'm encouraged about is mental-health treatment is covered in the basic benefits package. What I'm disappointed about is the benefit does not have full parity with other illnesses," says Dr. Michael Freeman, president of the Institute for Behavioral Healthcare, a San Francisco-based think tank concerned with the mental-health industry.


An estimated 60%-70% of the mentally ill have inadequate insurance. Almost 24 million American adults and 12 million American children have a serious mental disorder, according to the National Assn. of Psychiatric Health Systems.

But, if Clinton's plan is enacted by Congress, everyone gets something.

"It's an incredible improvement for those (underinsured) people," Freeman says. "For the rest, it's pretty similar to what a lot of the Fortune 500 companies offer or better."

There are other praiseworthy aspects of the plan. Clinton has avowed that no one should be refused medical insurance because of a pre-existing condition. Increasingly, people who have needed mental-health services have been refused any type of medical insurance.

"We are enormously pleased with the prohibition against pre-existing condition exclusions," says Wade Horn, executive director of Children and Adults with Attention Deficit Disorders, a parent-based organization with more than 400 chapters nationwide.

"We have been seeing a lot of people being refused treatment for ADD because insurers say, 'You were born with it. It's a pre-existing condition.' "

Clinton's plan also removes lifetime cost caps, such as the common $50,000 limit that is grossly inadequate for the treatment of most severe, long-term illnesses, such as schizophrenia or autism.


Those who criticize the President's mental benefit say they had hoped for more.

Clinton should have seized the moment to give mental health parity with other illnesses, Freeman says. The plan promises parity by 2001, but by not doing so now: "It perpetuates the stigma and second-class status of mental health," Freeman says.

But, according to Arons, it is impractical to think that full mental-health benefits could be introduced at one time without breaking the bank.

"That's a big jump," he says. "People know that (parity) is right morally and even clinically. But it's still a big jump in the service system."

Arons says that he expects some states to introduce parity gradually. For example, Maine has already legislated a phase-in of full coverage for several major mental-health disorders, such as bipolar depression, obsessive-compulsive disorder and autism.

But even if major mental illnesses achieve full parity in short order, many mental-health experts are concerned that people with more mild or moderate disorders will be handicapped by the limitations on outpatient services.


Under Clinton's proposal, people who need regular medication for a disorder, such as lithium for bipolar depression, would have unlimited outpatient visits for medical management. But someone not on a psychotropic medication would be limited to 30 psychotherapy visits.

"The problem with the outpatient benefit is it does nothing for the person in need of serious outpatient therapy," said Dr. Bryant Welch, senior policy adviser of the American Psychological Assn.

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