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More than 30 years of research have proven these findings to be consistent across the United States. Fortunately, psychological research and the application of this research have vastly improved the ability to diagnose and treat mental health disorders. Today, many of these disorders are just as preventable, controllable, or curable as physical illnesses.

Still greater strides are expected by the end of the 1990s, which the president and congress have declared "The Decade of the Brain."

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Suicide was the ninth leading cause of death in the United States in 1992, reports the National Institute of Mental Health (NIMH). For young people 15 to 24, it was the third leading cause. Research has shown that almost all people who kill themselves have a diagnosable mental or substance abuse disorder.

And overall, according to NIMH, 1 in 5 adult Americans will have a mental health problem during his or her lifetime that requires treatment. Even behind often normal facades, people with mental health disorders can be stricken with constant tension and fear, overwhelmed by persistent feelings of inadequacy or pessimism, affected by abrupt changes in mood and behavior, or handicapped by headaches or nausea that have no identifiable physical cause.

NIMH further states that clinical depression, which can totally incapacitate a person, costs an estimated $23 billion in lost work days each year. Significant symptoms of depression, which affect even more people, may account for 51% more disability days than the more severe, major depression.

All told, NIMH reports that mental health disorders cost the United States more than $150 billion each year-calculating the costs of treatment, social service and disability payments, lost productivity, and premature death.

Better understanding of mental health and broader access to health care for people suffering from mental disorders will go a long way toward reducing the staggering financial burden to individuals and the nation as a whole. At the same time, such understanding will help millions of Americans lead more productive and more fulfilling lives.

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Physically ill and older people are more likely to suffer from mental health disorders. More than half of Americans 65 years and older who are treated for physical illness in hospitals, clinics, and nursing homes also have at least one identifiable mental health problem.

Separated or divorced people are twice as likely as their married counterparts to have a mental health disorder according to a 1-month prevalence rate study by NIMH.

The same study indicates that at every level of society, poorer people are consistently more likely to have a mental health disorder than people who are socially and financially better off.

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Phobias, which are irrational fears such as claustrophobia (fear of closed spaces), agoraphobia (fear of leaving home), and acrophobia (fear of heights).

Panic disorders, which are marked by sudden attacks of irrational terror such as an overwhelming feeling of impending doom, racing pulse, sweating, and pounding heart.

Obsessive-compulsive disorders, which are illogical, ritualized, debilitating behaviors such as checking and rechecking appliances and locked doors, or endlessly repeating activities such as washing hands.

Posttraumatic stress, in which vivid flashbacks and nightmares can occur years after a traumatic event such as combat, rape, a plane crash, an earthquake, or a bombing like the one that occurred in Oklahoma City a few years ago.

Approximately 18 million Americans suffer from mood disorders, an affliction roughly divided between:

Severe depression, marked by persistent despondency, with disruptions in sleep, appetite, and energy level.

Bipolar disorder (also called manic-depressive illness), marked by extreme mood swings alternating between euphoria and deep despondency.

NIMH also reports that approximately 2 million Americans are afflicted with schizophrenia, the most chronic and disabling of the mental health disorders. Characterized by hallucinations, delusions, and bizarre behavioral and thought patterns, schizophrenia typically manifests itself in the late teens or early twenties. Only 1 in 5 patients recovers completely. Schizophrenia is so agonizing that 1 in 10 patients commits suicide.

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Depression may decrease appetite, leading to poor nutrition. It can decrease energy and motivation, leading to impaired mobility and decreased productivity. It also can disrupt sleep and aggravate pain from chronic conditions. Depression can produce reversible memory loss or confusion or acerbate cardiac problems by elevating blood pressure or pulse rate.

Anxiety can have similar effects and, in addition, can bring on fear of the very activities necessary to restore function after a physical illness.

The APA reports that many studies show that including mental health treatment as part of the overall treatment plan for people with certain physical illnesses, such as cancer and diabetes, can enhance recovery or halt progression of the disease, thereby using fewer medical resources.

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In addition, psychotropic medicines (i.e., medicines that act on the mind) may also be prescribed, often in conjunction with psychotherapy treatment. The vast majority of patients can be treated on an outpatient basis; many continue to pursue their normal activities as they recover.

It is unfortunate that many people who could benefit from treatment do not seek help because they are unsure about where to seek help, have limited mental health insurance coverage, or do not have any mental health insurance coverage. This situation will hold true, although to a lesser extent, even when the new Mental Health Parity Act* goes into effect in January 1998.

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Congress has also acted. In 1996, congress passed the "Mental Health Parity Act." This landmark legislation prohibits insurers from imposing lifetime- and annual-benefit limits on mental health services that they do not impose on services for physical health. Before passage of the Mental Health Parity Act, a typical insurance plan might cap lifetime mental health benefits at $50,000, but cap benefits for physical health services at $1,000,000. Once the act is carried out, insurers will no longer be permitted to impose a different limit on mental health benefits if both kinds of benefits are part of the health insurance package.

Thus, up until the time the parity act goes into effect, a family with both physical and mental health insurance coverage in one policy can incur catastrophic costs associated with the mental illness of a family member, although avoiding financial hardship if a physical illness strikes. This is because the latter situation is more generously covered, while mental health coverage is typically subject to low annual and lifetime spending limits.

However, as of January 1, 1998, under the new federal parity provision, group health plans that offer mental health and physical health benefits may not impose greater limits on one type than the other. This means that people who need mental health treatment and are insured under such a policy will not have to leave their jobs because they have exceeded their private coverage limit and must become eligible for public sources of care as an indigent.

Congress passed the Mental Health Parity Act with the realization that the financial security gained by families experiencing mental illness and the nation as a whole far outweighs the low cost associated with the act to insurers and employers. The Congressional Budget Office, the agency that determines the costs of various legislation, has determined that the Mental Health Parity Act will increase private insurance premiums by only 0.4%, or only four-tenths of one percent. Of this premium increase, employers will pay a mere 0.16%. One way for insurers to spread the remaining, extremely modest premium increase over all private health coverage is by raising the coverage deductible by only $5 per year.

The Mental Health Parity Act takes an important step toward ending discriminatory coverage of mental health services. But it is only a first step. Under the act, even those insurers who offer both physical and mental health services can still impose other coverage limits on mental health benefits; these limits could include copayment and other coinsurance requirements that are higher than those for physical health care, and treatment limits that restrict patient access to adequate mental health treatment (e.g., session limits).

In the article, "You Are Not Alone," NIMH reports that many people who need mental health care do not seek help. Many mistakenly believe their symptoms are of their own doing and that they can overcome their problems by themselves if they try hard enough.

Others avoid seeking help for their problems for fear they will be stigmatized by their family, community, or workplace. Some people don't realize they even have a problem, thinking the condition is normal.

In a recent consumer survey by APA, 47% of Americans said that they did not know when it was appropriate to seek help from a mental health provider. In addition, many people think that their symptoms are physical in origin, when actually their complaints stem from psychological factors. Examples include fatigue, dizziness, insomnia and weight loss brought on by depression, stress, anxiety, or grief.

But the main obstacle to seeking help are the strict limits imposed by insurance carriers on mental health coverage as opposed to coverage for physical conditions. Approximately half of all current insurance plans limit mental health hospitalization to 30 to 60 days per year. Many plans also have lifetime caps on in-hospital care. For outpatients, most plans restrict the number of patient visits or impose a dollar limit. For example, some insurers do not place restrictive limits on cancer treatment, but they do limit treatment for mental health.

Is mental health care insurance costly?

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No! Ending all discriminatory coverage for mental health services will save money for our health care system. According to a major analysis conducted for APA by the national actuarial firm of Coopers & Lybrand:

Full mental health parity, as provided for in the original Domenici-Wellstone amendment, would have increased premiums in the private sector by only an estimated 3.2%. But the original amendment did not pass. This increased expenditure would have been offset by a $16.6 billion decrease in public expenditures for mental health services as people with mental health disorders remained with their private insurance programs instead of being forced into federal and state programs as a result of coverage limits.

Meanwhile, timely treatment, access to treatment, and fair insurance copayments would reduce patient out-of-pocket expenses by $3.2 billion.

The provision of health coverage that does not distinguish between mental and physical disorders would lower national mental health expenditures by $5.5 billion.

As a result, under the original Domenici-Wellstone amendment Americans would have enjoyed an overall 0.5% savings in mental health costs nationwide.

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Design employee benefit packages to encourage employees to seek early intervention for mental health disorders, including drug and alcohol dependency. These plans should also encourage enrollees, when appropriate, to seek help from qualified mental health professionals rather than primary care physicians.

Promote the benefits of good mental health and early intervention through employee newsletters, workshops, and seminars in the workplace.

Educate health plan representatives and local provider association groups, such as medical societies and hospitals, on the benefits of using psychological services to improve health and cost-effective diagnostic testing.

Support efforts by mental health organizations to remove the stigma that still surrounds mental health disorders and prevents many people from seeking treatment.

For further information on this issue, please contact:

American Psychological Association
750 First Street, NE
Washington, DC 20002-4242
Attn: Practice Directorate
Phone: (202)336-5800
E-mail

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