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.
It isn’t hard to see why mental health parity laws make sense, Adams said. Mental illnesses should be treated like physical illnesses because mental health affects your physical health.
People suffering from a serious mental illness “die, on average, 25 years earlier than the rest of the population,” Adams said. “That’s one-third (of) your life expectancy lost.”
The average lifespan of a person with a serious mental illness is 55 years.
The shortened life expectancy results from a general lack of bodily health, Adams said. People with debilitating mental illnesses don’t exercise or eat regularly, and 43 percent of all cigarettes are smoked by someone with a serious mental illness.
Adams said people in the mental health field will have to wait and see if the Paul Wellstone Act improves mental health coverage in America.
One concern is that businesses, especially small ones, will stop offering their employees health benefits, he said.
“Who knows what the truth is,” Adams said. “The good news is that it’s now in the books.”
Will Spaulding, a psychology professor at the University of Nebraska-Lincoln, said the problem with mental health treatment in America is deeper than just getting people coverage.
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,” he said.
Unfortunately, the profession lacks a general consensus on what mental health illnesses even are. He said too many mental health care professionals approach mental illnesses as diseases and focus the treatment on curing the disease.
“A serious mental illness is more like a disability than a disease,” Spaulding said. “The goal of treatment is not to cure but to help the person overcome the disability.”
While teaching clinical psychology at UNL, Spaulding started a community transition program at LRC with his future wife Mary Sullivan and then-LRC Director Charles Richardson.
The community transition program took some of the most mentally disabled people, who suffered from schizophrenia and extreme depression, housed them in a separate facility at LRC and provided intense psychiatric rehabilitation. The goal was for the patient to someday help care for him or herself.
Spaulding said the program, which began in 1981, started receiving international attention by 1990. During that time, it was rehabilitating close to 50 percent of the patients to a point where they could be released from LRC to a less intense form of psychiatric treatment.
But since that time, funding for the program has been cut and it isn’t what it used to be.
“It still exists on paper,” Spaulding said. “But that’s pretty much it.”
As the kinks of ensuring treatment and insurance for the people who need are worked out, researchers are making breakthroughs that will save lives.
Spaulding said recent research has given those who treat mental illnesses the weapons needed to fight them, especially when the illness is discovered in its early stages.
For some college students in America, those early stages are right now. The most common age for schizophrenia to begin is the 18-24 age group.
For college students, lifestyle choices can make someone more likely to develop a mental illness.
“The main issue is stress,” said. Dr. Gonzalo Laje, an associate clinical investigator at the National Institute of Mental Health in Bethesda, Md. “Especially Among freshmen ... There is stress from being away from home, stress from a different load of subjects, stress from being without supervision.
“The entire transition can be stressful.”
Spaulding said stress can also be brought on by alcohol, drug use or just setting too high of expectations for oneself.
Laje said researchers at NIMH are concerned with stress because it can lead to both serious and non-serious mental illnesses.
For example, if someone’s life becomes too stressful, he or she can have trouble sleeping or suffer an anxiety attack. However, though these two affects can be crippling, they’re not the most serious mental illnesses plaguing 18 million Americans.
At the same time, a student with a genetic predisposition to mental illness who goes through the same amount of stress and can be pushed over the edge, including Tourette’s syndrome and schizophrenia.
However, Spaulding said the successs of LRC’s community transition program is proof that people suffering from mental illnesses can recover.
“We took people who had never known a world outside an institution and showed that there actually are recoveries,” Spaulding said. “We showed that you can do it.”
RYANBOETEL@DAILYNEBRASKAN.COM
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