Mental Health Parity Update: House Passes Paul Wellstone Mental Health And Addiction Equality Act
March 6, 2008 by Alicia Sparks, Mental Health Notes
Filed under Diseases & Conditions
It’s a happy day night morning (oh, man, I really need to work on a getting a regular sleep schedule going on) time for mental health patients, advocates, and family members and friends! Oh, who am I kidding – it’s a happy time for all Americans!
The House just passed the Paul Wellstone Mental Health And Addiction Equality Act (H.R. 1424)! (That link will take you to an explanation of H.R. 1424.)
You can view the official Yeas and Nays online. (Why does it seem like Republicans aren’t so keen on having mental health and substance abuse parity?)
To my understanding, now that both the Senate and the House have passed their respective versions of the bill, it’s now time to work out some differences and come up with a version they can pass on to the President.
So, we’re not quite there yet, but we’re definitely getting closer! Count on me and Mental Health Notes to keep you posted as updates are made available.
One of the biggest issues facing our nation is affordable health care. By choosing to use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as the basis for which group health plans offer coverage for mental health conditions, this bill is going to dilute the efforts we are making to cover those who really need health coverage. This manual includes such things as jet lag, academic problems, caffeine related disorders, and sexual disorders of various types, some legitimate and some self-imposed.
By diverting precious resources to issues such as these, which are trivial compared to issues that so many Americans are facing, we force private businesses to choose between paying for these “trivial” issues in order to include legitimate mental health coverage, or to refuse to provide mental health coverage at all. At a time when we want to get cooperation from business owners and insurance companies to help solve the health care crisis, this bill includes provisions that are going to end up hurting some of those who need the mental health care the most, because many businesses will choose to just not include mental health coverage.
I am so happy that this is finally getting more publicity than it use to. We really need to address it more loudly to the world. It is a very sad, scary, draining to the soul and family ordeal that no one really can understand even when they are going thru it. Thank you!
Robert: I’m afraid I’m not 100% clear on what you’re saying. Do you think the DSM should not be used? Even though it is the source doctors are supposed to use to diagnosis mental illnesses? Because of this, it kind of seems a given that the DSM would be involved in some way with a parity bill for mental health. It also seems as if your problem lies with the DSM, rather than the parity bill. What changes would you make to make this bill more effective?
Cheryl: I wholeheartedly agree. Fighting stigma is a passion of mine – mental health should be ignored by no one! Statistics say that one in four people have or are at risk for developing a mental illness. A friend of mine at NAMI has a saying, though, that everyone with a brain is at risk for mental illness of some sort, haha. Therefore, yes, it must be addressed loudly to the world!
I think there are a couple of issues running here.
First, mental health deserves attention. I have worked as a counselor to those struggling with mental health issues, and my family has been, and still is, effected by mental health challenges, so I’m in favor of gaining support for those who struggle with mental health issues.
Second, we have the urgent need to provide more affordable health care to more Americans. There are basic health services that everyone needs, but many aren’t receiving, and we urgently need to fill that gap.
The concern I have is that there are health concerns of varying degrees of urgency, both physical and mental. The DSM identifies issues that range from very serious to minor. I think it’s good to pay attention to all the issues, but, for example, mild OCD (or as my friend says, “CDO” which is just like OCD except it is alphabetical, as it should be!) does not merit the kind of concern that schizophrenia should.
So, just as I think we need to make it easier for people to receive necessary medical and dental care, I think we should make it easier to obtain mental health care. But I don’t think we should take an “all or nothing” approach. The parity bill is not just about validating mental illness as a legitimate health issue; it proposes to force businesses to pay for coverage for all the illness included in the bill. If we put too much into the bill, and enforce “all or nothing” too many will opt for “nothing” and we have then make no progress at all.
So, while I don’t have a problem with the DSM, I have a problem with including everything in it in an “all or nothing” bill. Similarly, I would have a problem with a bill that required businesses to pay “all or nothing” for all medical procedures, which included elective cosmetic surgery, hair implants, breast implants, and so forth. Doesn’t it seem more reasonable to put forward legislation that gets NECESSARY health coverage to the most people possible? I think it’s terrific that we giving more attention to mental illness. But if we try to enforce an all or nothing approach I think it is going to set us back, not move us ahead. I think a more moderate approach will move us further forward and get more help to the individuals and families that need it.
Thanks for responding to my previous comments and giving me a chance to think this out some more!
One of my favorite quotes which we tend to forget is that “Psychiatry is not an exact science.”
The DSM IV TR is the best we have, imperfect as it is. It will be need to be used as a basis for discussions on parity for mental health care because it is all we have.
I have been using DSM for many years and I see 2 major problems with it.
1. People don’t use it. They often make diagnosis based on some internal reaction or criteria. Some diagnosticians may think they know better or have the DSM memorized. I think this behavior has a lot to do with ego!
2. The DSM calls for judgement on the part of the diagnostician and subjectivie responses from the patient.
For example, the criteria for hypomania include: “pressure” to keep talking, “excessive” involvement in pleasurable activities with a potential for painful consequences, “inflated” self-esteem. Individual diagnosticians must decide what determines “pressure, excessive and inflated”. Some of this decision is based on their own experience, education and personality.
To add to theissue, subjective reporting is not always reliable.