Monday, March 31, 2008

Cleaning Up The Murky Politics (and Economics) of Mind-Body


--.op-Ed--

Yesterday The New York Times ran an interesting story in their Week in Review section, that begged comment. The piece, by Sarah Kershaw, was titled “The Murky Politics of Mind-Body” and focused on the shifting attitudes of mental health and how they have impacted a controversial new House bill . The bill would demand that insurance companies provide mental insurance “parity” - meaning that insurance companies could no longer set lower limits on coverage of mental health problems than on physical problems (including doctor and hospital visits, without higher co-payments).

The new bill has brought both insurance companies and the Senate up in arms. The Senate passed its own bill last fall (support by George W. himself ) that provided limited coverage. The real issue is the $3.8 Billion that the House bill would cost the government over the next ten years (even though the bill did include ways to off-set those costs). The NY Times article provides some very important points on the issue (you can read it HERE.)

How exactly did we bring the mind/body connection to a matter of “fine print ?” For example in the the article it asks, “Is an ailment a legitimate disease, if you can’t test for it?” This is sort of odd in a nation where ADD, ADHD, Bi-Polar Disorders, Panic and Anxiety Disorders, and Post Partum Depression (to list just a few) regularly get diagnosed and medicated – it’s just out of the consumers pocket. The FDA allows for medications to treat these types of “mental diseases/disorders” even though there are no diagnostics available in the strictest definition. The mind/body question disappears as long as we are paying for it.

Critics say that anything that would not show up in an autopsy as in depression or agoraphobia, cannot be equated to a physical illness – so should not be covered. Yet Erectile Dis-function diagnosis (which would have a hard time showing up in an autopsy…excuse the pun) is covered by most insurance companies, as are a limited quantities of the actual pills to “treat” the problem. I’m confused – its seems we are diagnosing and treating the "mentally ill" already (and those with other more "murky" and hard to definitively diagnose"dis-functions").

Mental health seems have been amputated from the human wellness model in the western world. Even though mentally ill cost this nation hundreds of millions of dollars by fueling the national homeless problem, the drug abuse epidemic, and crime. Mentally ill lose jobs, lose families and lose homes. Mentally ill self medicate using & misusing both prescription and street drugs, as well as alcohol. Mentally ill commit everything from petty crimes to the most gruesome criminal acts. None of these problems remain theirs – as we all pick up the tab on the ramifications of their illness, as does the federal government. Simply put, these costs are incurred because of the stigma and the cost barrier to diagnosis and treatment. Where is the financial savings Mr. Senator?

The other big problem is that mental illness is often a symptom of a physical ailment. Depression can be linked to anything from diabetes to low testosterone. Hallucinations can be linked to any number of neurological problems. Symptoms resembling Manic and/ or Panic Disorders can be linked to anything from Thyroid to heart conditions. If we tell consumers, through our attitude towards treatment and coverage, that mental health is not as serious of a problem as a straight forward medical condition – how many of those seemingly straight forward medical conditions are we missing, just because the patient isn’t going to get diagnosed ?

Another question we need to ask is how closely are our mental health practitioners working with the other slate of specialists and general MD’s ? How often does a patient coming in to see a Psychiatrist with heart palpitations and shortness of breath, claiming panic disorders get sent by a Psychiatrist back to their general MD (or heart specialist) for testing of heart problems - versus getting a prescription of Xanax ? How often do hallucinations get anti-psychotic medication instead of a full work up to see if there is a Neurological problem at work ? Yet if a person goes to see their general practitioner because of repeated numbness in their arm, chances are they will get sent to see a heart specialist. It seems psychiatry and mental health has long held such a massive stigma that there seems to be a significant division from other specialization in the medical field. Who ultimately suffers from this ? How often are we misdiagnosing because the Mind/Body practitioners have a distorted (or non-existent) process for collaboration?

The Mind/Body politic might be murky – only for those who stand to profit or lose profit. For the rest of us, those that know someone who is mentally ill, those of us who have passed a mentally ill person on the street, those of us who been either victim to or witness of a crime committed by a mentally ill person (in person, on TV, on paper), those of us who have some form of mental illness - -in other words…all of us (in one form or another), know that mental health is no less and no more important than the health of the remainder of our bodies. Somehow this big murky question seems answered in most of the rest of the world. In Canada and in most parts of Europe – there is nothing murky in mental health (everyone gets covered). Human beings individually, and for the greater wellness of society, deserve to get full coverage to be of healthy body AND mind. Hopefully this will be just one more step towards pulling mental health out of the shadows in which it has long existed.

And so it begs to question…who really needs their "head checked" in this scenario (in the "murky politics of mind/body")?


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