News & Publications: March 8, 1994

This article originally appeared in USA Today, March 8, 1994.

By Rosalynn Carter and Betty Ford

Health-care reformers need to think twice before bargaining away full coverage for mental-health and substance-abuse treatment. In the eyes of the public, these are not simply expendable extras.

A national poll released Monday reveals a new direction in public attitudes - away from some of the old stigmas that resulted in insurance coverage and health care that discriminated against people with mental-illness or substance-abuse problems.

Most of the voters surveyed believe everyone should have the same access to mental-health and substance-abuse services as they have to physical-health care. Sixty-two percent agree with the statement, "Mental-health and substance-abuse treatment should be covered to the same extent as physical treatment under national health-care reform."

They reject the predetermined, arbitrary limits on the number of treatments and the high co-payments for mental health and substance abuse that threaten to make their way into health-care reform. Voters believe decisions about access to care should be made by a health-care professional, not by a government bureaucrat or an insurance company.

These views are enormously encouraging to those of us who have been struggling to erase the stereotypes and misunderstandings that have surrounded mental illness and substance abuse for generations. For too long, these serious health problems have been burdened with judgmental and erroneous assumptions - that they are merely personal weaknesses, for example, or that they can be willed away.

As our knowledge and understanding have grown, these stereotypes have yielded to more enlightened views. We now know: Mental illness and substance abuse are definable and treatable, sometimes with higher efficacy rates than for some physical illnesses. And our knowledge of the brain and the relationship between mind and body have grown remarkably.

Justification for treating mental illness and substance abuse differently from physical illness is crumbling. That's as it should be. Intolerance ought not to be the excuse for sentencing millions of suffering adults and children to a lower standard of care.

The magnitude of these problems, and the pain they inflict, has spurred the two of us to join forces. We are united in an effort to highlight the need for a comprehensive mental-health and substance-abuse benefit as part of the final health-care reform package. We want to be sure it is not regarded simply as something to be traded away in the congressional turf battles that loom. We think elected officials should be aware that including mental-health and substance-abuse coverage in the final reform package elicits more, not less, public support for health-care reform.

With the flaws in the current health-care system foremost on people's minds, we have an unprecedented opportunity to build on the public's knowledge of mental-health and substance-abuse problems. What a tragedy it would be if this moment, and this momentum, were lost.

There are still many miles to go before mental-health and substance-abuse problems are completely freed from the myths surrounding them. But as we begin to discuss mental illness and substance abuse more openly, and as science continues to probe their causes and cures, they are gradually being recognized for what they are: serious health problems too often ignored at a great price to individuals and to society.

This is one case where the voters are ahead of their leaders, and policymakers should be listening to those voters. It would be a terrible and costly mistake if old prejudices were cemented in national policy because elected officials erroneously believed the public was not prepared to address them.

Let's not back down on a fight we might be winning.

Betty Ford is president of the board of the Betty Ford Center, Rancho Mirage, Calif.; Rosalynn Carter is chair of the Mental Health Task Force at the Carter Center, Atlanta.

Mental-health support (graphic)

Does including mental-health coverage make you more or less likely to support health-care reform?
Responses in a poll done for the Bazelon Center for Mental Health Law:
More likely 39%
No difference 20%
Less likely 16%
Don't know 24%

Require individuals to pay 50% treatment cost:
Oppose 58%
Favor 31%
Don't know 11%

Limit mental-health hospital coverage to 30 days a year:
Oppose 63%
Favor 27%
Don't know 10%