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MENTAL HEALTH'S CRYING NEED



Published: Fri, May 3, 2002 @ 12:00 a.m.



Los Angeles Times: It's rare for a president to give a speech on mental health. But it's wise. On Monday, President Bush decried how the mental health system lets "too many Americans fall through the cracks," leaving people whose brains have somehow betrayed them stuck on the street or in prison before help is given, if it's given at all.

That nails the problem. But Bush so far is missing his chance to contribute to the solution. He should embrace, if only in its basic outline, legislation that could help fix the mess he described. The so-called mental health parity bill -- by Sens. Pete V. Domenici, R-N.M., and Paul Wellstone, D-Minn., -- would compel health plans to offer equal payment for the treatment of certain mental illnesses and other physical ailments.

On Monday, a trade group representing HMOs denounced the Domenici-Wellstone bill as impractical, saying it would "add billions of dollars to health-care costs at a time when 40 million Americans lack access to health insurance and many more are struggling to afford the coverage they have."

The bill is not nearly as fast and loose with cash as the trade group suggests. Last year, lawmakers modified it to exempt firms with 50 or fewer employers, and this year its authors are offering to exempt employers that can show that complying would increase their annual premiums by more than 2.5 percent.

Still, soaring health-care costs are a major problem. Employers' average premiums rose 13 percent last year. Given this economic reality, some truly sick people simply are not going to get all the help they need, which is why the bill must be worded with surgical precision to provide care for those most in need of help.

Pandora's box

The Congressional Research Service recently concluded that the Domenici-Wellstone bill would require coverage for "all medically necessary treatment of psychiatric conditions listed in the Diagnostic and Statistical Manual of Mental Disorders." That manual, however, is a Pandora's box of ailments and afflictions, not all of which pass muster as serious in realms where common sense prevails.

Should health plans, for example, cover nightmare disorder ("the repeated occurrence of frightening dreams that lead to awakenings from sleep') jet lag, caffeine-induced sleep disorder, substance-induced sexual dysfunction, and partner relational problem ("a pattern of interaction between spouses or partners characterized by negative communications")?

Common sense -- and medical science -- recognizes, however, that many mental illnesses are as serious as a heart attack. Yet health plans routinely discriminate against people whose brains are diseased, as evidenced by the fact that many plans levy $5 co-payments for cholesterol drugs but $50 co-payments for drugs that can silence the voices that destroy psychotic patients' lives.

President Bush has shown that he grasps the sad reality of mental illness and its impact on families and society. Now he and Congress need to correct the disparity in how health plans treat the mentally ill.




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