Robin Kitchell's 13 year old
son suffers from manic-depressive disorder. Because of his medication
and psychotherapy, he manages a pretty normal life; he keeps up
with his schoolwork, plays on the football team, and is popular
with his friends. But every year right about now, his insurance
benefits run out, and Robin and her husband must pay $150 a week
out of their own pockets to get their son the treatment he needs
to keep on functioning.
The recent White House Conference on Mental Health chaired by Tipper
Gore featured Robin and other people in same situation, along with
the Vice-President and Mr. and Mrs. Clinton. No one there could
understand the logic of Robin's situation. Mr. Clinton and Mr. Gore
both called it outright, illegal, discrimination. After all, if
this young man had a serious, chronic "physical" illness no insurance
company would be allowed to rule that he had exhausted his benefits
halfway through the calendar year; or to charge a higher deductible,
or a higher copay, or arbitrarily limit the amount of service he
could receive.
People with mental health problems are so used to this situation
that we take it for granted and don't see it for the discrimination
that it is. It's great to see the first ever White House Conference
on Mental Health, great to see Mrs. Gore an enthusiastic cheerleader
for a national campaign to end discrimination. She notes how times
change, how we used to think segregation was the natural order of
things, how we used to be ashamed to talk about cancer. "This is
the last great stigma of the 20th Century," she notes. "We need
to make sure it ends here and now." But there are powerful forces
against her. "Your rates will go up!" is the first cry we will hear
from the insurance industry and its apologists, despite tons of
evidence that accessible mental health care reduces overall healthcare
expenditures by helping people stay in good physical health and
by preventing catastrophic costs when the individual breaks down
under stress.
There are other, subtler forces too. Robin Kitchell has been fighting
with her school system for years to get them to provide some reasonable
accommodations for her son, to no avail. But when he had to be admitted
to a psychiatric hospital last November, suddenly the school decided
he really did have a problem-in other words, that he might be dangerous-and
proposed to send him to a special facility where he would be isolated
from his peers four months from graduation, unable to continue the
normal curriculum he had managed just fine.
I'm sure the school officials are well-meaning people. Everyone's
scared of kids blowing up the school. Newsweek runs a cover story
"Spotting Teens in Trouble" with a picture of a demonic-looking
young man. You don't have to be a genius to read the implicit subtitle:
"and sending them away somewhere."
Good intentions aren't enough to justify discrimination any more.
Neither are economic rationales. I'm with Tipper, let's end it here
and now. But the fear and shame associated with mental illness are
so pervasive that we're going to have to be educated about how to
spot discrimination when we see it.
Maybe some of the fear and shame made sense when we had no treatment
for the mentally ill, when a "nervous breakdown" meant a lifetime
ruined. But now we have better success treating depression than
we do heart disease. Medication and psychotherapy are available
and effective. We just have to make sure people can get the treatment
they need.