The burden of mental illness is grossly underestimated and far worse than most people realize. There are economic concerns, personal concerns, professional concerns, and debates about laws and ethics. From the economic standpoint, depression alone costs over 30 billion per year in direct costs, such as loss of employee productivity and lost lives due to suicide. It is also the leading cause of disability in people over 5 years of age.
Insurance companies and the new fad of "maintenance care organizations" are two of the largest contributors to the problem. Psychiatry is often singled out for cuts in coverage and benefits, leading to the maltreatment of millions. Since the first health insurance company started business, mental health has been known as the step-child in terms of benefits and coverage. One insurance executive reasoned that mental health patients are the least likely to complain about the coverage they receive, as they are more vulnerable than the average person. Current incentives within maintenance care and insurance companies stress cost cutting instead of quality care. The "experts" on the utilization review boards of insurance companies are not trained in psychiatry, nor even given basic mental health training. Unlike mental health practitioners, the utilization boards do not have to accept responsibility for the decisions they make regarding the mental health treatment that any given person receives. They have not had to pay the consequences when a life is lost due to the lack of treatment available. These utilization boards, who do not know you, have not treated you, and who are encouraged to deny lengthy and perhaps costly treatment, are making the decisions that can very well cost you your life. Not your psychiatrist, not your counselor. Not even a licensed doctor. Thus, the introduction of maintenance care organizations has resulted in limited access to mental health services, not to mention lost lives.
Lately, there has been a surge of complaints against health maintenance organizations who are refusing treatment for the mentally ill. Congress has found that people with mental illnesses are vulnerable to abuse by both their insurance companies and their caretakers, including lack of treatment, medication, and institutionalization. Recently, a news program aired a special on patients who could not get the treatment they needed, because their health plans would not pay for it, even though the contract specifically stated this kind of treatment was covered. This is known as "patient dumping", another cost effective way of denying treatment to a patient even though it is clearly stated in the insurance provider contract as a benefit. Instead of allowing twenty therapy sessions, perhaps only ten would be approved. Certain medications are not covered, even though it might be the only medication available to treat the disease. Stringent utilization requirements define a crisis situation as a suicide attempt. A person can be in crisis long before they are suicidal, and they shouldn't have to attempt to take their own lives before they can receive the treatment they deserve. Many cases illustrate the desperation that people with mental illnesses can come to feel. In one instance, a man took his own life after his health plan removed him from suicide watch and sent him home. In two other cases, two young women attempted suicide after having their therapy sessions stopped by their health insurance. In yet another case, a schizophrenic became violent and attempted to murder someone after he was sent home from an institution when his health insurance implemented a "cap" on the amount of treatment the mentally ill receive. In a day when the stigma of mental illness is lessening, this kind of attitude that the insurance companies have is appalling. If people with mental illness are to receive the treatment and respect they deserve, the behaviors and policies of insurance and maintenance care companies will have to change. The problem is of frightening proportions, but there is relief in sight.
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