The enormous controversy surrounding federal healthcare legislation indicates that it's a debate about our future, and like the future, its outcome is far from certain. No matter what your feelings regarding the issue, the final result will impact nearly all of us - individuals, our families and our neighbors, young, old and in-between, employees, employers and job seekers. Our ultimate decision as to the form, reach and coverage of our healthcare delivery system means that it will continue to play an immense role in shaping both our personal and national well-being. Yet it goes even beyond that: it will reveal our priorities by identifying those health concerns that we've decided are vital to wellness and then specifying how we will ensure the availability of and access to care for ourselves, our loved ones and our community.
As Illinois' chief advocate for a comprehensive mental healthcare system, I'm heartened to note that under current legislation being considered in the US House of Representatives, treatment and services for both persons coping with mental illnesses and those suffering from physical ailments are viewed equally. As I write this, at least one House initiative mandates that all insurance plans cover mental health and substance abuse treatment on the same terms as other health conditions. Among other things, that means that it would extend the provisions of the Mental Health Parity and Addiction Equity Act (US Public Law 110-343 effective on January 1, 2009) to also forbid discriminating against mental health consumer-purchasers of individual insurance coverage or, alternatively, choosing to enroll in small group plans.
Not only would such language make it easier for mental health consumers (i.e., persons with a preexisting condition) to purchase insurance but also it would reduce their out-of-pocket spending. The first proviso would make appropriate health care more accessible, the second, more affordable. It would also provide that under Medicaid's Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT), children and adolescents served by Medicaid would be assured that any assessment of their health needs would include an examination for possible mental health problems.
These and the other like provisions that speak to our nation's mental health needs are as welcome as they are overdue. Our "silo-ed" healthcare system has far too long been based on the outmoded premise of a mind-body disconnect. That outdated notion is directly correlated to impeding recovery for untold numbers of Americans coping with mental health challenges.
An adult living with a diagnosed mental illness has a life expectancy twenty-five years less than the average US citizen's! Persons with serious mental disorders have co-occurring medical illnesses such as cardiovascular disease, diabetes, hypertension, respiratory, gastrointestinal disorders and malignant neoplasms at unusually high rates.
Consider depression. Among the most prevalent of mental ailments, it affects nearly 19 million US residents annually. A forty-year study of 1,200 Johns Hopkins Medical School alumni released in 1998 found that graduates with a history of clinical depression were twice as likely to develop coronary artery disease. In March of 2004, the American Medical News, an AMA publication, linked it to hypertension, stroke, heart disease, diabetes, obesity and asthma. A similar link was noted by Women's Health Initiative researchers in the same year when they reported in the Archives of Internal Medicine that sub-clinical depression, often unrecognized by doctors, may increase the risk of cardiovascular disease among women ages 50 to 79.
And it goes both ways. The onset of a physical health crisis or an ongoing struggle with poor physical health takes its emotional toll planting the seed that can allows mental illness to take root. So it's not surprising that while the costs to our national economy of untreated mental health concerns may be hidden they're not illusory:
- Mental illness is the leading cause of disability in the US and Canada between ages 15-44
- Conservatively, mental illness and substance abuse cost employers an estimated $80 billion annually in indirect costs
- Employees that suffer from depression alone cost employers $44 billion a year in lost production
Such data make it clear that fully integrating mental health in our national healthcare system is critical to our national state of wellness and, additionally, has a direct bearing on our living standards. Consequently, failure to systematically and uniformly deal with mental illness not only takes a major toll on our personal lives but harms the nation's economic productivity as well. No matter your prescription for resolving the healthcare debate, the benefits of sound mental healthcare are much too important to ignore. Incentives for pursuing mental health recovery and resilience are critical to advancing the health, wealth and general welfare of all Americans.