Obstacles to accessing mental health care.

• Author: Menaged, Samuel E.
• Position: Psychology

UNLESS you have faced it in your own family, it is difficult to describe the upheaval and pain that accompanies mental illness. So, let us paint a picture.

Imagine your daughter or wife suffers from anorexia and bulimia. She weighs just 92 pounds, about 80% of her ideal body weight. She eats less than 300 calories a day, the equivalent of two pieces of bread and a slice of cheese. If she eats any more than her self-imposed calorie limit, she then "purges" by forcing herself to vomit. She is weak, emaciated, and beginning to show the signs of malnourishment, including cardiac problems. Emotionally, she is crippled. She cannot work or attend school. She is ravaged by anxiety and depression. She is unable to participate in a relationship.

Make no mistake, her eating disorder is not a lifestyle choice. She is the victim of a disease, just as a cancer patient is. There is a difference, however, one that can ultimately be deadly for the victim of mental disease--treatment for her sickness is often not covered by health insurance.

As managed care has increased its hold on the American health care system, mental health has become one of its most-beaten victims. To reduce spiraling costs, insurers often look at mental health benefits as the first place to cut. In fact, from an actuarial perspective, mental health costs are among the most difficult to predict and therefore the most risky. Each course of treatment can be wildly different from patient to patient. For example, a person suffering from depression may respond well to drug therapy with minimal need for professional "talk" therapy--the more-expensive component in the treatment mix. However, another patient with the same level of severity may require several medications and ongoing psychotherapy over the course of many months or even years.

While some health plans have eliminated or drastically reduced benefits, other insurers outsource the administration of mental health benefits to companies that specialize in the management of such benefits. In these scenarios, the company acting as administrator operates under a "risk contract," meaning it contracts with providers and hospitals to administer 100% of the mental health care necessary for a certain number of insurance subscribers. In return, the administrator receives a fixed dollar amount. Any monies left over after the provision of care go into the pockets of the administrator. Therefore, the less care the administrator has to pay therapists and hospitals to provide, the more money it makes. So, it is easy to see how the administrator may define "necessity" for care differently than a health care provider, patient, or patient's family.

As...