The symptoms of the nation's ailing health-care system are easy to recite. But making an accurate diagnosis and prescribing the proper treatment are difficult. Even with the best of intentions, we might misdiagnose the problem, prescribe the wrong treatment and kill the patient.
This might happen if Congress follows President Bush's lead and passes legislation mandating mental health insurance parity.
The basic idea behind parity legislation is to cover mental illness on the same basis as physical illness. Arguments offered by proponents of parity are well-known: Although one in five Americans suffers from a mental illness, few seek treatment because of the stigma; mental illness is just like physical illness; and new drugs help millions recover quickly.
Each of these claims is misleading, false and dangerous. The stigma associated with mental health treatment has nothing to do with the extent of insurance coverage. This stigma has more to do with the messages that people know come with a psychiatric diagnosis: that they are damaged, that no treatment can cure their illness and that prescribed treatment--usually drugs and more drugs--would be needed indefinitely.
In 1996, outpatient psychiatric drugs accounted for 9% of the nation's direct spending on mental health. This figure has increased dramatically since, with the drug companies' successful marketing. Sales of antidepressants--drugs repeatedly found to be no more effective than placebos--reached $10.4 billion in 2000, and $6.5 billion more was spent on antipsychotics and anti-anxiety drugs.
The mantra of the mental health movement--whose major lay and professional branches, such as the National Alliance for the Mentally Ill and the American Psychiatric Assn., have deep financial roots in the drug companies--has been that mental illnesses are just like physical illnesses and therefore should be covered by insurance. But mental illnesses are precisely not like physical illnesses in at least two fundamental ways: Their diagnosis bears no resemblance to diagnosis in any other branch of medicine, and mental patients routinely get treated against their will.
Before 1980 and the third edition of the American Psychiatric Assn.'s then virtually unknown Diagnostic and Statistical Manual of Mental Disorders, most mental health practitioners did not even make official mental health diagnoses. With insurers wanting standardization to pay mental health claims, however, the American Psychiatric Assn. redesigned the manual to become the standard for insurance payment. No diagnosis, no payment. As a result, the number of mental illnesses has increased, along with new drugs to treat them.
