VOLUME 30 , NUMBER 7 July/August 1999
White House conference on mental health
Though attendees emphasized biological treatments, conference helped to showcase the value of psychological services.
By Lisa Rabasca
Monitor staff
President Clinton and Vice President Gore pushed for full mental health parity at the first-ever White House Conference on Mental Health on June 7.
The conference brought together 500 members of the mental health community, including about 20 psychologists. The day provided a forum for Vice President Gore and his wife, Tipper, to debunk myths about mental illness and showcase promising new treatments. President Clinton seized the day to urge Congress to require employers to offer workers mental health insurance equal to regular health coverage.
"This is the first time mental health issues have received this much attention since the Carter administration," says Raymond Fowler, PhD, APA's executive vice president and chief executive officer.
Fowler, along with APA President Richard Suinn, PhD, represented the association at the meeting. Before the conference, APA actively worked with the White House to identify major psychological, social and behavioral issues within the mental health field.
But before full mental health parity can become a reality--and be embraced by Congress--behavioral scientists will need to continue to show the psychological causes of mental health problems and to promote the benefits of treatments.
"The conference was a good initial step but unless there is adequate follow-up and follow through, its long-term benefits will be minimal," says Rep. Ted Strickland. PhD, (D-Ohio). "We're not going to change public opinion and perceptions or influence decision-making within the House and Senate by having a one-day event, regardless of how well it is organized or how noble the intentions are behind it."
'The last great stigma'
Much of the conference focused on dispelling the myths about mental illness and decrying prejudices against people with mental illnesses--including insurance coverage that excludes mental health services.
"This is the last great stigma of the 20th century," conference chair Tipper Gore said. "Initially we wouldn't talk about cancer or AIDS either, but now we do," she said, comparing mental illness to these diseases.
Gore talked publicly about her own mental health, revealing that she was clinically depressed after her son, Albert, nearly died when hit by a car 10 years ago. She was one of several speakers who offered personal accounts of how their mental illness was effectively diagnosed and treated, reinforcing the idea that mental illness is like any other malady.
"These are real diseases of a real organ--the brain--and should be treated just like any other medical illness," Steven Hyman, MD, director of the National Institute of Mental Health (NIMH).
The administration is seeking to lead the way in eliminating the stigma of mental illness by providing full mental health and substance abuse parity to the federal government's 9 million employees and dependents in 2001, said President Clinton. The coverage, he said, will establish the same limits, deductibles and co-payments for mental and physical health, including medications, to treat mental illness.
"Too many people can't get the treatment they need because of lack of parity," Clinton said, urging Congress to hold hearings on national parity legislation.
APA's Fowler hailed the announcement for avoiding a narrow, severe mental-illness-only focus, saying "Most encouraging is the administration's plan to provide full parity for all people with mental health problems, without discriminating by diagnosis. This example will show that we can provide full parity for mental health care at a very modest cost."
Current law requires insurance companies to impose the same annual and lifetime benefit dollar limits for physical and mental health services, but a report by the NIMH last year found that some managed-care companies are imposing other restrictive measures such as higher deductibles and co-payments. Congress is considering two proposals that would strengthen the current law. (See article, page 10.)
Clinton announced several other initiatives during the conference, including:
These initiatives and the conference make mental health a "full, legitimate partner" in overall, physical health, says Lance Laurence, PhD, past president of the Tennessee Psychological Association. "Mental health has been given the blessing of the federal government and can be put on the table for public policy discussions," he says.
Hyman, NIMH's director, for instance, discussed the effectiveness of psychotherapy.
"We can see that psychotherapy alters the brain," Hyman said, as he displayed slides showing changes in the brain of a patient who had been successfully treated for anxiety with cognitive behavioral therapy. Medication is a valuable tool for fighting mental illness, he said, but most patients also need psychotherapy and psychosocial treatments.
But while Hyman's very brief comments reaffirmed the efficacy of psychotherapy, APA President Richard Suinn, PhD, said a more balanced presentation of the benefits of psychotherapy would have offered a more comprehensive perspective.
Challenges ahead
Although pleased with the conference, some psychologists who attended expressed concern that the administration oversimplified the issue of mental illness by viewing it as a brain disease.
"There was a real push for a simple disease model where you have an illness and take pills," says Stanley Sue, PhD, professor of psychology and psychiatry in the department of psychology at the University of California, Davis. "There was little discussed about the exciting research on the outcomes of psychotherapy."
And, although the one-day conference highlighted the importance of mental health treatments, some say that enacting full parity--or even funding more research and treatment--will take political will by a Congress that has not seemed overly interested.
"Getting this on their radar screen is difficult," Rep. Brian Baird, PhD, another psychologist-legislator who spoke at the conference. "It's much easier to advocate for research money and treatment for illnesses without a stigma, such as breast cancer or diabetes."
It's now up to psychologists to promote the behavioral components of mental illness.
"Our task is to flesh that out," says Dean Kilpatrick, PhD, director of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston. "We need to keep the conversation going."
And, psychologists need to lead the conversation, says Sue of California.
"We need a concerted effort now because some people would like to promote medication as the solution," he says. "We have to be careful we're not falling back on a medical model approach to mental health because that would isolate psychology from the main thrust of mental health."
Stephen Pfeiffer, PhD, executive director of the Association for the Advancement of Psychology, agrees that psychologists need to promote the benefits of psychotherapy.
"We already possess the documentation to support the fact that psychotherapies are effective, we simply have to do a better job of insuring that the message reaches the right people occupying positions of power," says Pfeiffer. "The inadequate and narrow biological focus of the White House Conference on Mental Health should act to motivate us to make it a top priority to inform members of Congress and the administration about the psychological and social components of the mental illness model."
Psychologists who attended the conference were given "extraordinary access to people who have power and seem open to receiving follow up information and suggestions," says Kilpatrick, who is also the president of the South Carolina Psychological Association. "A lot of how valuable the conference is dependent on what we do as follow up."Y
Before the conference, APA met with White House staff and submitted briefing papers on scientific developments in psychosocial treatments, access to quality mental health services, mental health services for children and adolescents and mental health needs of under-served populations, which can be found on APA's Web Site: www.apa.org/ppo/whitehse/whindex.html.
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