FORGOTTEN PATIENTS THE MENTALLY ILL.

• Author: BOULARD, GARRY

THOUSANDS OF PEOPLE SUFFER SOME FORM OF MENTAL ILLNESS THAT INSURANCE DOESN'T COVER. SOME STATES ARE TRYING TO CHANGE THAT.

Texas Representative Garnet F. Coleman was not really surprised to wake up one morning in 1994 as an inpatient at the Menninger Clinic in Topeka, Kan, For years he had been suffering from depression and was now preoccupied with the goal of at long last finding a way to, at least, manage his condition.

The surprise came when he discovered a young woman patient on suicide watch who was soon sent packing.

"Do you know what suicide watch means?" asks Coleman, who was elected to the Texas Legislature in a special election in 1991. "It's when there are people sitting outside the door of your room, running in whenever they hear some noise, interrupting your sleep with flashlights in your eyes, trying to make certain you haven't killed yourself yet."

The woman was forced to leave the renowned clinic, Coleman recalls, because her insurance did not cover her illness.

"I never realized until then how unjust these things can be," says Coleman. Right then, he resolved that he would do something to help the millions of people who are forced to face debilitating and enormously expensive illnesses of the mind alone, almost always without the support of insurance.

REACHING PARITY WITH PHYSICAL ILLNESSES

Returned to the Legislature after at long last getting a diagnosis--the lawmaker suffers from a mild form of bipolar disorder, which is easily controlled with daily medication--Coleman began to lay the groundwork for what would eventually become an historic piece of legislation. He wanted health insurance "parity" for the treatment of mental illnesses on a par with benefits for the treatment of other diseases.

Texas already had such a law but it covered only state employees. Coleman wanted to expand it to everyone who works in the big state. Although not parity, his successful 1998 law provides a substantial amount of minimum mandated benefits for inpatient days and outpatient visits. With it's passage, Texas became one of the largest of more than two dozen states to address the issue of what to do about the thousands of people who suffer from different forms of mental illnesses and are unable to get coverage for treatments and medication.

"Just look at it this way--it is really nothing more than a question of fairness and democracy," declares Virginia Senator Edward Houck, who last year sponsored one of the nation's few full parity laws that includes treatment not only for a variety of mental illnesses, but chemical dependency too.

"In a broad sense this has been discrimination of the very worst sort," says Houck, whose tenacity on the subject is clearly seen in the long road his legislation traveled. He began to work on a parity bill in 1994, boning up on the complex interpretations of what constitutes a mental illness, and, even more thorny, whether dependence on a chemical substance is rooted in willfully bad behavior or a mind-induced need.

THE MOOD IS CHANGING ACROSS THE COUNTRY

The Virginia legislation, coupled with partial parity bills passed in New Jersey and California, give evidence of a trend, contends Bob Carolla, who monitors state lawmaking on mental health issues for the National Alliance for the Mentally Ill in Arlington, Va. "The overall legislative pattern has all been on the up side," he says.

With the recent enactment of a New Mexico law, 21 states now require full parity, according to NCSL's Health Policy Tracking Service. In some cases, the new laws have been sparked by the example of legislation in other states.

"Two things really helped our cause in Oklahoma," contends Senate President Pro Tem Stratton Taylor, who sponsored a successful parity law last year.

"The first thing was that we were able to get our hands on a report done by the Rand Corporation that showed that, although there was a very tiny increase in insurance premiums as a result of similar legislation elsewhere, the increases were more than offset by the savings of having people not miss work or not being institutionalized once they got the treatment they needed," he says.

But the second motivation for Oklahoma law-makers was nearly as powerful. "Texas has just passed its bill, and it was signed by Governor Bush," says Taylor. "That had a real effect on our lawmakers who decided that if Texas could do it, so could we." In fact, Oklahoma passed broader coverage than Representative Coleman managed to get through in Texas.

HOW TO REACH THE REMAINING MULTITUDES

Despite such advances, however, many mental health advocates worry that millions more Americans are without coverage. According to the first-ever surgeon general's report on mental health, released in December, some 15 percent of the country's population at any given time use some...