The Health Care No One Wants to Talk About

It isn’t easy to sell people on the need for mental health care; the average Joe gets nervous when you bring up the mentally ill. They aren’t pretty, these sick people. Margaret Mitchell, the bag lady who was shot for waving a screwdriver at a Los Angeles police officer, turned on her family when they tried to help her. One relative told The Times that her preferred way of drowning out their pleas was to make bizarre throat-clearing sounds.

Poster children don’t work. Ever seen a child racked with mental illness? What you notice--if the illness is of the sort that is noticeable in childhood--is that they periodically act as if it isn’t clear that either of you is a human being. This is what mental illness does to people, even little people. It cuts them off from the part of their spirit that can make a connection, be empathetic, touch life.

A few celebrity sufferers have raised awareness, but it’s double-edged. Audiences admire their commitment, but come away feeling secretly, unpleasantly one-up. It’s one thing to talk about the stigma of breast cancer or the smoking that leads to emphysema. But mental illness involves both your brain and the self it impacts. To throw your disease open for public consumption is, at the same time, to turn your character into an exhibit. How can an audience feel about the dignity at stake here? How healthy is the person who has to boast about being well?

Not even appeals to society’s better nature yield much persuasion. Society recoils from the mentally ill. How else is a species to feel about weak links that can pose danger to themselves and others? The repugnance overwhelms reams of evidence that even the most severely afflicted can be cured with good psychotherapy and the right medication. Better to imagine it’s all Frasier and Woody Allen and Dr. Laura than to accept that this isn’t one of those problems that can be ignored or punished until it disappears.

*

Maybe it’s because of this difficult backdrop that two bills working their way toward the governor’s desk this summer have such a momentous feel. Assemblywoman Helen Thomson’s AB 88 and Sen. Richard Polanco’s SB 468 would, with the stroke of a pen, do more to eliminate the stigma of mental illness than a decade’s worth of confessional speeches or poster people: It would force insurance companies to cover it like any other need for health care.

The two pieces of legislation differ in the breadth of coverage they would mandate: Polanco’s bill covers all mental health care deemed medically necessary by a provider, whereas Thomson’s bill limits itself to the illnesses that are most severe. A psychiatric nurse, Thomson has targeted ailments that tend to cost most in public resources and that are most often treated with a combination of drugs and therapy (schizophrenia, severe depression, etc.), as well as illnesses most devastating to children (anorexia, for one).

Naturally, the insurance companies are screaming. They would. They’re populated by average Joes with average prejudices. They yelp stupidly about “Woody Allen syndromes,” in which mobs of healthy Californians would supposedly rush into treatment, as if any healthy person would want it. They warn baselessly that premiums will skyrocket and businesses will drop coverage for tens of thousands in response.

The truth is that neither bill is expected to raise premiums by more than a buck a month per person. Twenty-four states already mandate parity, some far more broadly than either Thomson or Polanco wants to, and so far, their insurers are doing fine. In fact, most have found that paying for mental health care has saved them money because mentally healthy people get fewer physical ailments: In Texas, the cost of care for enrollees in managed care dropped after Gov. George W. Bush signed parity into law.

*

The truth is, studies repeatedly have found that mental health care works if you find a therapist who knows what he or she is doing. (Which is hard to do if you’re too ashamed to ask around.) The success rate for treatment of schizophrenia is higher than that of heart disease. I have seen homeless people blossom into happy, fully employed citizens, just by talking to a gifted psychologist once a week for a couple of years.

It’s nothing short of amazing that these truths are finally getting a hearing. It will be a grave disservice if the Legislature and governor don’t at least approve Thomson’s measure, though legions more could be helped with Polanco’s bill. Then the job will be to sell the insurance companies on doing right by the claims they’re supposed to cover, for a scourge that strikes one in five average Joes a year.

*

Shawn Hubler’s column appears Mondays and Thursdays. Her e-mail address is shawn.hubler@latimes.com.