Integrating Mind and Body in Health Care

Saranac Lake recently broke ground with a golden shovel event to establish “The Garden for Change,” to reduce the stigma against mental illness. What a great idea! Kathy Fadden, the Program Director of the Mental Health Association in Franklin County told me she was inspired to create “The Garden for Change,” to increase attention to the as yet not passed “Timothy’s Law,” which would make mental health insurance discrimination illegal. We forget about mental health, as it continues to receive discriminatory treatment by insurers and legislators due to the tendency to prejudicially regard those with mental health conditions. There is a distinct lack of parity in health care that leads to inadequate health insurance coverage for the treatment of emotional conditions. 

Timothy’s Law was proposed following Tom O’Claire’s son’s suicide, after he exhausted his ten managed care authorized psychotherapy visits, and his health insurer refused to provide additional needed psychotherapy treatment. The O’Claire family was not able to pay for their son’s needed treatment. Where does discrimination against mental health care come from?

In part, mental health discrimination stems from the belief that persons suffering from mental illness are some how acting irresponsibly. In effect, this manner of thinking regards mental illness as an excuse for poor performance. This social misunderstanding leads to painful stigmatization of those who experience mental illness. In turn, those who suffer emotionally either deny their conditions or seek to prevent others from knowing. As a group, those who suffer emotionally tend to not effectively advocate for much needed appropriate insurance coverage due to this stigma. Insurers take advantage of this reality by providing far less coverage for mental illness than they provide for physical illness.

Social rejection of mental illness has a long, well established history. Centuries ago, many regarded mental illness as the result of “possession.” It was not until the eighteenth century, that mental illness was studied “rationally.”  Yet, despite nearly a century and a half of an increasingly, scientific, professional and humane approach to mental illness, signs of a residual discriminatory pattern continue.

The most glaring example of discrimination can be seen with insurance reimbursement and “managed care” insurance for the treatment of emotional conditions. Consumers are increasingly aware that psychotherapy is essential to the effective treatment of the common forms of mental illness such as anxiety, depression, phobias, and addictions, etc. Yet, insurers structure their benefits to favor medication management over psychological treatment.

Effective psychological treatment may involve short, medium or long term approaches, depending upon the condition. Psychological treatment involves insight and understanding, cognitive restructuring, behavior modification and the enhancement of self esteem and self confidence. Research has shown that the best results occur with some form of a blend of psychotherapy and medication.

A more subtle example of mental health discrimination involves the tendency of health professionals to ignore the emotional component of physical disease. Heart disease and diabetes, for example, are illnesses that may involve behaviors such as smoking, poor diet and inadequate exercise as well as stress. A strictly medical approach ignores the need for modification of those associated emotional and behavioral conditions, which either contribute to the illness or inhibit recovery. According to NIMH, depression is a risk factor for heart disease, along with high blood cholesterol and high blood pressure. Additionally, research has demonstrated a high level of depression among those with heart disease, which may worsen the condition.  In view of this, informed consumers might wonder why their insurance plans; physicians and hospitals do not provide an integrated, mind-body approach to prevention and healing.

Unfortunately, the answer seems to be short sighted, misinformed insurers and professionals who find it easy to ignore the problem. After all, if consumers do not ask for an integrated approach to health care, why provide it? Lack of consumer awareness has a lot to do with the problem, that’s why I am writing about it. Yet, integrating physical and mental health treatments, and elevating mental health insurance availability through mental health parity (i.e.,Timothy’s Law) are quite inexpensive and highly cost effective measures. If you become less depressed and anxious, stop smoking, loose weight, you probably will become healthier.

Raymond Havlicek, PhD

Lake Placid, NY