I read this article about the addition of mental health care to the ACA a couple of days ago and found it encouraging:
The piece itself was informative, indicating that the Affordable Care Act mandates treating mental illness on a par with physical illness. It is about time, in my opinion, and we should finally have one more tool in our arsenal for contributing to a healthier, happier, more productive and safer America.
What intrigued me though was reading the hundreds of comments, many of which dismiss the importance of creating this legal balance in favor of arguing for or against the expenditure of public funds (in theory) to make mental health care more accessible and affordable. Logically, if it is both, more people will get it and hopefully, earlier. There is a problem getting any mental health care for children, much less affordable (and for seniors as well, as Medicare does not subsidize it, I guess with the idea that older people are more likely to get dementia in one form or another and the care for that and related disorders is prohibitively expensive, sadly).
It is hard to believe that in the 21st century, a wide swathe of the American public questions the legitimacy of diagnosis and treatment of mental, psychological, and emotional abnormality. What is really disturbing is the fact that before a doctor can treat a patient presenting at an emergency room in a compromised mental/emotional state, the physician on call has to contact the insurer and to trigger an intricate process of approvals that must be obtained before treatment can be administered. Sometimes it is denied and the person is released without treatment. So an insurer is making a mental health decision that affects patient and society alike. With what qualifications?
The fact that the American public does not demand this treatment parity is concerning. It is likely due to the long held misunderstanding of the behavioral and social sciences stemming in no small part from their origins in the 19th century where on the one hand, psychiatry branched off from medicine in Europe, specifically in Austria, Germany and Switzerland and was frowned upon by the medical community as quackery. Social sciences had their origins in Europe as well and were the prerogative of the wealthy who with time and funds were able to treat the study of society and culture as they would the humanities, simply writing narratives on various topics from a library desk.
Today all the behavioral and social sciences in the United States are taught and practiced as quantitative and qualitative empirical disciplines, virtually indistinguishable from the life and physical sciences. Yet these prejudices persist to the detriment of both the individual with the disorder and society at large. Unfortunately too, much of what passes for treatment is little more than the oversimplified prescription of psychoactive drugs, when a more complex and nuanced approach consisting of an array of treatments, including a variety of behavior modification therapies would be more effective and safer, and perhaps in the long run, more cost effective.
The fact that parents and the health industry alike are reluctant to order treatment for children, early, aggravates this problem. There are children in whom problems manifest from a very young age, well before school years. Parents and other family members are often reticent to admit that their child has a problem, especially if an adult member of the family has a similar or related problem. There is still a stigma attached to having any kind of mental condition as if it is something that the individual, no matter how young or old, should be able to control themselves and failing to do so is a weakness that indicts the sufferer.
If someone develops a sore or a lump, or sustains an injury, they have no qualms about seeking prompt treatment. But if that same individual were to endure bouts of depression or suicidal thoughts, s/he is likely to grapple with it in silence for long periods of time, often with tragic outcomes.
After experiencing their first episode of psychosis, a mentally ill person will wait two years before seeking treatment. According to a 2009 Institute of Medicine report, half of individuals with a mental health diagnosis first experience it by age 14, but do not seek treatment, on average, until the age of 24. Since emotional and behavioral disorders first appear in childhood, early intervention programs have been shown to produce better outcomes and reduce ongoing costs.
This is especially important for parents of teenagers. Consider children who go away to school and have to deal with overwhelming pressures away from the caring structure of the family unit. Even though colleges long ago abandoned in loco parentis, some schools are attempting to provide a measure of support to their students, who are enduring a variety of serious challenges that come with being at school on their own, including managing the demands of their studies as well as the strains that come with getting along with strangers as emerging adults, one of the most challenging of life lessons at any age. Enabling them to cope effectively means a higher graduation rate, fewer suicide attempts and a more cohesive and stronger school community. Good colleges know this.
Medical care should hold its umbrella of safety over the entire individual and in some cases, family members, since the home dynamic plays a key role in the identification of underlying causes, and maintenance and improvement often cannot take place unless the whole environment is considered and modified.
This care should be cradle to grave as a matter of routine, and because illness has implications for the productivity and functioning of a civilized society, it should be mandated and covered without question, admittedly with some rational form of means testing applied to enable a full range of treatment to be administered to all, with a sliding scale of individual vs collective contribution to bear the costs involved.
Further to this subject, here is a new trend rapidly gaining favor among researchers themselves:
One day, this will include a full range of testing to identify markers for multiple cognitive disorders as well. It will be considered part of a standard checkup that babies undergo from their first well-baby visit.
But in order to do that, we have to get our insurers, medical community, and general public on board, which means abandoning antiquated notions of shame associated with this vital dimension of human functioning.
Images: who.intl.com, umc-gbcs.org