WASHINGTON, D.C. — Six years after Paul Wellstone's fatal plane crash in 2002, the former Minnesota senator posthumously got what he'd always wanted: legislation to end discrimination in insurance coverage for people with mental health problems.
In October, former President George W. Bush signed into law the Paul Wellstone Mental Health and Addiction Equity Act of 2008, paving the way for more insurance rights for the mentally ill.
Julio C. Abreu, senior director of government affairs for Mental Health America in Alexandria, Va., thinks a law like this is long overdue.
"You would be hard-pressed to find another illness that goes as untreated as mental illness," Abreu said. "Eighty percent of the children in juvenile detention centers have some form of mental illness, and we wouldn't stand for that if it were some other disease or complex."
A clear need
Until recently, costly mental health treatments that most group health plans didn't insure contributed to why many people didn't get medical help.
But the Wellstone act requires insurance companies who provide medical and surgical benefits to also provide substance use and disorder benefits.
"It has been a joint effort," Abreu said. "It's great to see that through after 12 years."
In recent years, the need to provide mental health treatment for returning war veterans has pulled mental health issues to the forefront of political discourse.
As the ranking member on the Senate Armed Services Committee, Sen. Ben Nelson, D-Neb., was one delegate on Capitol Hill who advocated for mental health treatment for soldiers.
"It is not unique to these wars," Nelson said of post-traumatic stress disorder. "But the focus is unique to these wars … the bad news and good news are the same. It's generating more awareness."
Nelson said the Mental Health Parity Act, which goes into effect on Jan. 1, 2010, is a step in the right direction.
"You've got to admit there are mental health issues that need to be treated the same as physical illness," he said.
But the Mental Health Parity Act does have its shortcomings. When the law is enacted, it will not mandate that insurance companies cover people. Instead, it merely requires companies who already provide people health insurance to also cover mental health and addiction treatment.
What it means for Nebraska
The Lincoln Regional Center houses and treats some of the most mentally ill people in the Nebraska.
Scot Adams, the director of the center, doesn't know if the Mental Health Parity Act will affect the center's day-to-day work.
"(The Wellstone Act) won't affect the regional center much because most of our clients are poor," Adams said. "(The patients have) debilitating mental illnesses ... we're not talking about having a bad day."
Adams said the individuals who have been committed to LRC suffer from diseases like schizophrenia, bipolar disorder or extreme depression. The diseases have already crippled their lives, and most of them don't any jobs, let alone health insurance.
And even if the act is successful, and more insurance programs begin covering people's mental health treatment, it doesn't specify what type of treatment they will be getting.
Will Spaulding, a psychology professor at the University of Nebraska-Lincoln, said there's not an agreed-upon consensus as to how mental illnesses are perceived by those treating them.
Are they diseases, with the ultimate goal to cure of the illness? Or are they disabilities, with the goal being to help the sufferer learn to live with the complications?
"A serious mental illness is more like a disability than a disease," said Spaulding. "The goal of treatment is not to cure, but to help the person overcome the disability."
Spaulding created a Community Transition Program at LRC with his wife Mary Sullivan, a social worker, and Charles Richardson, a psychiatrist at LRC. The program started in 1981 and was in full swing from 1985 through 2004.
"Waiting on e-mail from Spaulding that documents successes of CTP during those years, have it by sunday
He said many mental health treatment centers, including LRC, focus on confinement more than rehabilitation, and a parity act won't change that.
"It begs the question of what type of treatment they will receive," Spaulding said of the Mental Health Parity Act. "It leaves the power structures in place and allows psychiatrists to spend very little time in treatment (with their patients)."
"We should be thinking of an insurance system that is more like disability insurance," Spaulding said.
Jeanne Atkinson, communications and legislative services director for the Nebraska Department of Health and Human Services, said the average daily population at LRC is 187 patients, with 85 in the general psychiatric services and 102 in the forensic mental health service.
The average daily cost for each patient is $451 per day.
How many total came through in 2008?
Adams said "99 percent" of the money LRC has doesn't come from its clients or their insurance companies but from the state.
The general psychiatric wing of LRC houses patients who were in treatment at another facility elsewhere and were sent to LRC because it's more secure and intense than other treatment centers.
The majority of patients at LRC are in the forensic mental health services, which means they have been ordered to the center by a judge.
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