How We Make Mental Illness Worse

By Rosalynn Carter

This article originally appeared in USA TODAY, Nov. 17, 1992.

I and so many others have been fighting myths and misconceptions about mental illness for decades. Yet stigma and discrimination against those with mental disorders persist, and nowhere is that clearer than in our nation's health-care system.

One in five adults and 12% of our children have emotional or mental disorders. Today, more than ever before, these people can overcome their illnesses and live productive lives. The advent of new medications, the frequent success of rehabilitation, and advances in understanding the biology of the brain and the interdependency of mind and body have underscored mental health as part of health.

Just as mind and body are one, equitable mental-health benefits must be a part of health-care reform. There must be equal status for mental and physical health-care services.

The leaders of 50 national mental-health organizations will gather at The Carter Center in Atlanta Thursday to discuss principles for ending the discrimination that has denied those with mental disorders access to appropriate services for far too long.

Each organization has its own priorities, but the field needs to step forward to speak with a unified voice. We are at a crossroads, where we have the opportunity to bring mental health into the mainstream of our nation's health-care system. We must ensure that mental health is integrated into any overall health-care package.

But that's not enough. A range of mental-health services should be available to every American experiencing mental illnesses. Health-care reform must not provide care based on a hierarchy of pain but embrace all those who suffer from mental-health problems. This includes serious mental illnesses, such as schizophrenia and manic depressive illness, alcohol and substance abuse problems, depression, anxiety disorders, and a host of other emotional disorders.

It should promote mental-health practices as well as provide for prevention, early intervention and follow-up care. It also should offer physician training and treatments based on the knowledge that mental health is an integral part of every person's health.

Mental-health benefits should be based on the same principles and subject to no greater limitations than other health-care benefits. Today, people who could be productive, contributing members of society remain incapacitated because they have no way to pay.

Hundreds of thousands more, and their families, face serious economic hardship and even financial ruin to obtain care simply because their illness is categorized as "mental." The stark reality is that our payment system discriminates badly against those in need of mental-health services.

The coordination of care is an important part of the service system. While health-care reform must address unnecessary treatment, reform also must recognize patient needs, direct patients to the best possible providers and support the most effective care. Prevention of unnecessary treatment and assurance of quality care must be monitored through careful review by competently trained professionals.

Appropriate mental-health care is not free, but lack of proper care will have devastating financial consequences: Time is lost from work and other productive activities; medical conditions are complicated; family members, including children, are impacted not only financially but emotionally; there is cost to taxpayers when people become so disabled that expensive long-term care is the only option; and, finally, lives are lost through suicide. The cost of pain and suffering is incalculable.

Health-care reform must reflect the advances of a civil and intelligent society that has come to better understand the reality of mental disorders. By 2000, I would like to see a greater range of mental-health services based on individual need, preference and choice.

I hope service providers, physicians and others will be prepared to care for diverse groups and individuals regardless of age, ethnicity, language or gender and will respect the role of the individual in determining a treatment plan. I hope for universal access with no exclusions based on existing or pre-existing conditions.

The failure to address mental-health-care reform will lead not only to unnecessary suffering but also to extraordinary public and private expense. Creating a health-care system that reflects parity between physical and mental health acknowledges the need to see people as whole human beings, and it recognizes the worth of every person regardless of his or her disability.

The impact of mental illness (grapic)

Cases going up
'80 35.3 million
'87 40.5 million
'90 41.4 million

Who's covered
Insured 153 million
Underinsured 50 million
Uninsured 37 million

What it costs us
Direct costs (exluding substance abuse) $55.4 billion
Indirect costs (lost productivity) $73.9 billion

What treatment costs
Individual psychotherapy in office (45-50 minute session) $101
Ind. psychotherapy session in hospital $120
Family therapy session $151
Psychiatric diagnostic interview $130
Initial consultation in office $131
Initial consultation in hospital $151
Group psychotherapy, per person $50

Rosalynn Carter chairs the task force on mental health policy at The Carter Center, Atlanta.