From the White House Conference
on Mental Health-
For someone who's been trying to advocate for mental health for
twenty years-and often feeling like we're losing the battle-it was
a pretty special event. To have the President and Vice President
say so clearly that it's simply illegal discrimination to have one
kind of insurance package for "physical" illness and another for
"mental" illness, is very encouraging. To have Tipper Gore bouncing
around on the dais like a cheerleader, saying "This is the last
great stigma of the 20th century and we have to make sure it ends
here and now"-that's great news. Now we need to work to keep the
momentum going.
It began very early Monday morning (June 10) with a breakfast reception
in the East Room at the White House. As I'm gawking at the presidential
portraits I notice I'm standing next to Donna Shalala. Over there
is Representative Patrick Kennedy, next to Janet Reno. I introduce
myself to Kathy Cronkite, who seems as dazzled as I am, and I don't
feel like such a hick. I try to balance coffee, notebook, and a
plate of little things for breakfast and introduce myself to more
people. Most seem like they're directors of advocacy groups, or
researchers. A few are, like me, wondering how they got invited.
Finally someone introduces Mrs. Clinton and Mrs. Gore. Hillary,
in a pink pantsuit and pearls, looks thin and a little tired, and
I wonder if she really wants to campaign in New York. She welcomes
us all to the White House and says a few kind words about Tipper,
and I get the feeling that they really do like each other. Tipper
is dressed more soberly, but she's got plenty of energy. She talks
about how she's been looking forward to this event and how meaningful
it is to her. It's clear she really cares deeply about this issue.
All three hundred of us reluctantly leave the White House and board
buses which carry us to Howard University, where we break up into
small discussion groups. Mine is about improving education for health
care providers. Representatives Nancy Johnson and Lois Capps (D-California)
are on the panel, as is Togo West, the Secretary for Veterans Affairs.
It's unfortunate that he's there, because that means there are a
lot of VA employees in the group who want to talk about what a good
job they do. Our Congressional representatives want to talk about
prevention, and there is actually some good discussion about how
to engage primary care physicians and schools in the task of helping
people get help. One theme emerges which carries through the day-the
public doesn't recognize how treatable mental illness is, and how
much unnecessary damage is done by not treating it early. Nancy
Johnson acknowledges in public that managed care has devastated
mental health.
Then it's time for the big plenary session, the event that made
the six o'clock news. We have to pass through another set of metal
detectors and a bunch of guys in suits and sunglasses who look like
they were the Georgetown defensive line, because the President himself
is here for this. This is where the Clinton-Gore campaign style
really looks effective. Mr. and Mrs. Clinton, Mr. and Mrs. Gore
enter and take seats on a long dais where furniture is arranged
in three conversation groups. Tipper takes over. She's so excited
she's literally hopping with energy. But she gets serious. She reminds
us all of the effects of the pervasive stigma about mental illness-one
of the chief effects being that it keeps people from getting treatment.
No one talks about it, everyone pretends it isn't there, but depression
alone will affect 19 million adult Americans this year, and its
impact is increased because people fail to get help in time. She
talks about her own experience: she had a delayed reaction to a
traumatic event, and she had enough sense to recognize that she
needed help. She got therapy and medication, and it worked.
Tipper turns to Mike Wallace, seated on her right. He describes
his experience with depression: fifteen years ago, enmeshed in a
libel suit that challenged his integrity and professionalism, he
found that he couldn't think, couldn't make the smallest decisions,
couldn't sleep at night, and was mired in the kind of psychic pain
that's so hard to describe. "I was lower than a snake's belly."
He would call his doctor every night, and his doctor told him "you're
strong, Mike. You can take it." And of course that made Mike Wallace
feel even more that there was something horribly wrong with him.
Finally he just checked himself in to a psychiatric hospital. He
was treated effectively. He says he had one relapse, when he got
cocky and went off the medication. "I'm on this for life," he says
now, without a hint of shame or regret.
There is a nice moment as Wallace tries to break off, fearing that
he's monopolizing things. Tipper urges him to continue: "It's important,
because you're a man and you come forward and you can help so many
men." Wallace says he never told anyone about this. People who knew
him were very supportive, but there was too much shame to talk about
it openly. Finally, one night he was on Bob Costas' interview program
at about 1:30 in the morning, and he thought, who would be watching
this except people who are going through exactly what I did? And
he suddenly told his story, and the wire services picked it up as
news. You get the feeling now that Wallace is justifiably proud
of that impulse.
Mrs. Gore goes on to talk to two other recovering patients. One
is a young man with schizophrenia, a second-generation Chinese man
who to his deep shame once in the midst of a delusion struck his
father. But his father stood by him and now, with the help of medication,
the young man has finished college and is employed as a teacher.
The second is a young woman, a college student, who has battled
anorexia since she was 14. At one point she was down to 20 calories
a day. President Clinton, who has been silently attentive up till
now, breaks in: "How much weight did you lose?" She was under 90
pounds, and this is a tall, large-framed woman. Tipper wants to
know what she got out of starving herself. "It's hard to explain.
I just know that the more weight I lost, the more in control I felt."
There was much more. Tipper announces that this is the beginning
of an organized national campaign to end stigma. Hillary interviews
the director of the National Institute of Mental Health, who gets
interrupted by applause twice when he talks about the value of psychotherapy-applause
because for the last ten years NIMH has been working too closely
with the drug companies, focusing too much on brain research. She
interviews Congresswoman Lynn Rivers, who herself battles manic-depressive
illness. Rivers notes that she's fine now, but at one point-when
she just had a regular job-she had to spend half her take-home pay
on medication alone. Her insurance, like so many others, had restrictions
on how much it would pay for mental health care.
Then it's Al's turn, and as Tipper gives him stage directions he
breaks in to say "I hope you all can see how proud I am of her,"
to great applause. His interview with Robin Kitchell is perhaps
the most pointed of the day. Mrs. Kitchell's 13 year old son suffers
from manic-depressive disorder. Thanks to 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.
Mr. Gore points out that this is discrimination, pure and simple.
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. "If he had a broken leg, you'd expect
him to get treated, wouldn't you?" notes the Vice President. "Same
thing with a mental problem."
Mrs. Kitchell faces other, subtler forces too. She can't really
talk to other mothers; no one wants to hear about this. She 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.
Mr. Gore notes that there are many in the insurance industry who
will say that we can't possibly afford parity for mental illness,
and he turns to his next guest, an executive with Bank One, the
country's fifth largest bank. By providing easily accessible preventive
mental health care to all their employees-including counseling at
their on-site health clinics-they have seen their overall health
care costs decline dramatically. Productivity goes up, absenteeism
goes down, and the costs of "physical" health care decline. As the
day goes on we hear about more employers who are finding similar
savings-Motorola, Black & Decker.
Then it's the president's turn. I am one who has never understood
why people think so highly of him as a speaker; to me, he's always
sounded flat, as if he was reading. But seeing him in person, watching
his thoughtful delivery and the way he establishes rapport with
the audience, I'm impressed. He seems to be throwing the full weight
of his office behind Tipper's campaign, noting that it's been far
too long that discrimination against mental illness has been allowed
to stand-both in terms of health insurance and in terms of attitudes.
He announces that all insurance companies that contract with the
federal government-more than 300 of them-will henceforth be required
to provide exactly the same benefits for mental illness as they
do for physical. In other words, no higher copays, no higher deductibles,
no annual limits. He acknowledges that the parity law passed two
years ago hasn't worked-the insurance companies have found loopholes
that make it completely ineffective-but pledges to get the law fixed.
But this is not his show, and he knows it; he does a good job of
trying to be low-key and statesmanlike.
There's more in the afternoon, but it's all anticlimactic. At the
end of the day, we board our buses again, this time for a trip to
the vice-president's house for a farewell reception. Unfortunately
there's a heat wave in Washington-the mercury hits 100 degrees-and
this is outside in a tent. But we're all having a good time by now.
Tipper and Al come out again, mostly just to thank us for participating.
Judy Collins sings "Amazing Grace." As darkness falls, we exit through
the vice president's house. There's Tipper's drum set right at the
foot of the stairs. She's going to need it.