Mental Health Advocates Seek Expanded Coverage in Insurance Plans : Legislation: Individuals and groups are lobbying the Clinton Administration to put mental illness on the same footing as physical ailments in reform proposals.

In a perverse way, Raymond Bridge knew he was fortunate when doctors decided after five years that his daughter, Edith, suffered from a physical disorder rather than mental illness. Now, at least, his insurance would pick up more of the cost.

Bridge, a federal worker who lives in northern Virginia, exhausted the lifetime caps on five different insurance plans before the diagnosis was changed. “We went through our savings and huge sums of money from both my family and my wife’s family,” he recalled.

“I am a middle-class person, but it is not enough to protect me if I or a member of my family needs psychiatric hospitalization for an illness that lasts a lifetime.”

It’s disparities in insurance coverage like the one encountered by the Bridge family and many others that inflame mental health advocates. They are lobbying the Clinton Administration to put mental health illness on the same footing as physical ailments when the President submits his health reform legislation to Congress.

So far, the Administration seems unlikely to satisfy them. Hillary Rodham Clinton said recently the legislation would provide a “very good beginning” but fall short of the parity that mental health advocates want.

While parity has always been a goal, economists and actuaries are having trouble agreeing on what it would cost, said Robert O. Boorstin, a special assistant to the President and spokesman for the White House’s health care reform task force.

“What they’re looking to do is build in enough flexibility in the benefit to account for the various degrees of illness that people experience, because not every depression is alike and not every schizophrenia is alike.”

Boorstin said the Administration’s plan is likely to require patients to pay a portion of their psychotherapy, in hopes of curbing its use, and include “a very strong package of benefits on the other things--inpatient and outpatient, particularly case management, things surrounding getting drugs.”

He said drugs for treating mental illness will be included if other prescription medication is.

What you won’t see, he said, is lifetime caps on treatment for mental illness. “That is one of the really egregious pieces that is never going to be allowed,” said Boorstin, who suffers from manic depression and spent years arguing with his insurance company over its lifetime cap on mental health benefits.

The impact of Clinton’s decisions in mental health--merely one area of the overall health policy puzzle--are enormous.

The American Psychiatric Assn. estimates that 40 million adults and 12 million children suffer from mental illness, ranging from severe, life-threatening diseases like schizophrenia and depression to midlife crises and stress problems. Also included are attention-deficit disorders and hyperactivity in children, eating disorders that largely afflict women and abuse of alcohol and drugs.

Many existing insurance plans cover 80% of the cost of treating physical disease but 50% of the treatment cost for mental illness. Many also limit the number of doctor visits and hospital stays for mental illness and limit the amount of reimbursement in a patient’s lifetime.

Richard Coorsh, spokesman for the Health Insurance Assn. of America, said many employers favor these restrictions in the insurance they purchase for workers as a means of holding down costs.

The 50% co-payment for mental health care emerged with 1973 legislation authorizing health maintenance organizations, said Dr. Mary Jane England, president of the Washington Business Group on Health, which represents 190 of the country’s largest employers. Traditional indemnity plans soon adopted the same policy. England said limits were set on hospital stays because insurance companies concluded that patients were spending more time in facilities than necessary.

She said many employers favor a managed-care approach with a more flexible benefit for mental health.

Rob Wilbert of Harrisburg, Pa., said insurance companies have a “30-day mind-set” when it comes to mental illness.

His daughter Jennifer, then 16, was hospitalized for four months in 1988 with schizoaffective disorder after she started seeing and hearing things that weren’t there. Wilbert’s HMO provided 30 days of coverage, and the hospital is suing him for $51,000.

His current plan also limits hospital coverage for mental illness to 30 days.

“This is something that our children were born with,” said Wilbert, who also has a son with the disorder. “It’s going to last a lifetime. You can say diabetes is similar. When you get it you have to control it by treatment, and if you don’t that individual is going to be in serious trouble.”

Wilbert supports legislation sponsored by Sen. Pete V. Domenici (R-N.M.) that would put coverage of severe mental illness on an equal footing with severe physical illness.

A report by an advisory council of the National Institute of Mental Health prepared for Domenici found that the nation could save $2.2 billion if it broadened coverage for mental health, largely because patients would have less need for general medical services.

Dr. Steven F. Sharfstein, a psychiatrist and president of the Sheppard & Enoch Pratt Health System in Baltimore, said he has seen the impact of “un” and “under” insurance on the mentally ill. “These men and women and adolescents and children delay seeking diagnosis and treatment and prematurely terminate treatment because of the economics of care,” he wrote to the First Lady, who is leading health reform efforts for the Clinton Administration.

Bridge, whose daughter Edith remains under treatment, said he was “extraordinarily lucky” because as a federal worker he could change health insurance plans every year, and there was no bar on coverage of pre-existing conditions.

“Since mental illness is a lifelong chronic condition, anyone with mental illness has a pre-existing condition,” he said.

Mental health advocates say those without Bridge’s resources often are forced into bankruptcy, and their relatives placed into the public health system. Some of the severely mentally ill become part of the homeless population. Others end up in jail.

“Here we have the opportunity to wipe out, to merge the public and private systems and remove the second-class status and often third-class care that is facing people,” said Laurie Flynn, executive director of the National Alliance for the Mentally Ill.

Bryant Welch, the American Psychological Assn.’s senior policy adviser for health care reform, said less emphasis should be put on expensive, inpatient care. He also opposes restrictions on how many times a patient may receive outpatient treatment.

“If you have two people with depression, one person may respond to a couple of outpatient treatments, another person may need a whole lot more time,” agreed Dr. Richard Small, a psychologist in Reading, Pa.

About Mental Illness . . .

Statistics on mental illness, as provided by the American Psychiatric Assn. Some of the figures come from a report by the Advisory Council to the National Institute of Mental Health.

* 40 million adults suffer from some form of mental illness each year. About 5 million people suffer from severe mental disorders, such as schizophrenia, manic depressive illness and severe forms of depression, panic disorder and obsessive compulsive behavior.

* 12 million children suffer from some form of mental illness.

* One-third of the homeless have severe mental disorders.

* 30,000 Americans commit suicide each year. Suicide has become the third-leading cause of death among teen-agers.

* The direct cost of treating all mental disorders in 1990 was $67 billion. The cost of treating severe mental disorders was $27 billion, including $7 billion for long-term nursing home care.

* Making mental health coverage for the severely mentally ill commensurate with other health care coverage would add $6.5 billion in new mental health care costs. However, it could produce a decrease in the cost and use of general medical services by people with severe mental disorders.

Source: Associated Press