We mental health professionals are usually an optimistic lot, often determined to nourish hope in the face of crippling despair. Our hopes for less discrimination against the mentally ill were buoyed by the 1999 release of two landmark reports by U.S. Surgeon General David Satcher summarizing the state of our knowledge concerning psychiatric disorders and advocating for more aggressive suicide prevention efforts. These reports recount the terrible toll of psychiatric illness, noting that psychiatric conditions are responsible for more premature death and disability than other, more visible forms of sickness, such as cancer, respiratory disease or infectious illnesses.
Satcher reminded us in these reports that suicide is the eighth leading cause of death, and he lamented the continued stigma and pernicious discrimination faced by the mentally ill when seeking employment, health-insurance coverage or simple acknowledgment of their struggles.
Both reports by the surgeon general are a call for action, a well-reasoned, common sense plea for rational, equitable cures for the mentally ill.
Steve Chapman’s May 9 column would also seem to be a call for good old-fashioned common sense. Leveling the worst form of criticism imaginable toward President Bush–likening him to Bill Clinton–Chapman argues that government ought not intrude into matters best left to corporate America to sort out. Tapping into alarmist fears of destroying the employer-sponsored health-insurance system, Chapman urges us to heed managers’ concerns over the estimated 1 percent rise in premiums brought about by mental-health parity coverage.
If the employers’ lobbyists say they can’t afford to extend health-insurance coverage to the mentally ill, we should listen to them. It’s as simple as that.
Extending further Chapman’s arguments for placing the public trust in the hands of big business, it seems to me that he should promote the dismantling of the Occupational Safety and Health Administration (employers wouldn’t subject their employees to unsafe conditions, would they?), the Environmental Protection Agency (they certainly wouldn’t pollute our air or water!) and the Equal Employment Opportunity Commission (surely they are always fair in their employment practices!).
Chapman’s opinions are merely another indication that stigmatization and discrimination against the mentally ill are still with us, albeit here disguised as economic reasoning.
There is no rational excuse for funding mental illness differently from more obvious and familiar forms of illness. Our society has delegated the dirty business of rationing mental health care to the managed-care industry, which doles out treatment to the fortunate few in a whimsical, profit-driven manner. Millions of people suffering from psychiatric illness forgo treatment altogether due to economic barriers held in place by irrational fear, a myopic underestimate of the toll of mental illness and simple discrimination.
All of these sentiments are found in Chapman’s opinions. If Chapman believes we can trust employers to properly manage our second-leading cause of disease burden (mental illness) based solely upon their economic self-interest, I would encourage him to look up the definition of the term “delusion.”
