MENTAL HEALTH, SUBSTANCE ABUSE COVERAGE IS COST-EFFECTIVE

"Mental health parity" is insurance coverage for mental health and
substance abuse on apar with coverage for other diseases. Parity
legislation is pending in the New York state Senate. The same bill passed
the New York State Assembly by an overwhelming vote of 139 to 11. Thirty
five of the 50 states have passed mental health parity laws.

I am puzzled to read of opposition to this legislation on the part of the
New York State Conference of Blue Cross and Blue Shield plans. It is easier
to understand the position of the business community: They have been led to
believe such insurance will break the bank.

The bank is already broken, and it obviously isn't due to coverage for
mental illness and substance abuse. This coverage is part of the solution,
not part of the problem. The Blues have long been in a position to know
this. They claim their coverage is so limited because businesses don't want
to pay for it.

Lack of communication is to blame here. The Onondaga County Medical Society
has come to realize we need to talk to and educate businesses and unions.
Is mental health and substance abuse parity cost-effective?

Numerous studies have shown the added cost of this kind of coverage is less
than four percent. The fascinating outcome is that total medical costs come
down.

This is not hard to explain. People suffering from mood and anxiety
disorders have a multitude of serious physical complaints. In the absence
of good mental health coverage, these complaints are presented to
internists and family physicians. Primary care physicians embark on
extensive work-ups, including laboratory and radiological studies.

Panic disorder is a good example. As a psychiatrist, I see people with
panic disorder every working day. I recognize it based on an interview
alone. I also assume anyone coming to see me may be depressed.

People with undiagnosed panic attacks can arrive in emergency rooms in
ambulances, with symptoms that mimic a cardiac event, pulmonary emergency,
etc. They emerge from work-ups with a multitude of presumptive diagnoses
and little relief. Of patients presenting with chest pain who have negative
work-ups, 80 percent turn out to have panic disorder, major depression or
both. The delay in diagnosing depression raises total medical costs by 23
percent. The managed care industry's own study shows patients with
untreated or under-treated depression make 50 percent more outpatient
visits and have health care costs two to three times higher than those of
non-depressed people.

To understand why this is such an enormous cost driver, look at the numbers:

29 percent of the adult population suffers from mental or addictive
disorders, according to the surgeon general.

Of adults between ages 18 and 54, 16 percent have anxiety and 7 percent
have major depression or other mood disorders.

With modern treatment, major depression yields a success rate of 70-80
percent, according to the National Institutes of Mental Health - better
than most cardiac treatments.

The World Health Organization projects depression as the second leading
cause of disease in the world by 2020. It now ranks No. 4, worldwide. In
the United States, only severe heart disease is associated with more
disability than depression.

How does this affect the business community? Employers encounter problems
with absenteeism, "presentism" (present but not productive), tardiness,
missing deadlines, disorganization, decreased performance, interpersonal
conflict, accidents, incidents, job turnover, sick time, even suicide.
According to the surgeon general, in 1999 the direct costs to business of
lack of parity coverage for mental illness was at least $70 billion, mostly
in the form of lost productivity.

What about substance abuse coverage? A study done in California found that
every dollar the state spent to treat alcohol and drug disorders saved
taxpayers $6 in future costs. Health care costs and crime-related costs
were down by $1.5 billion.

This is not a matter of dueling statistics. This is the last bastion of
insurance industry discrimination, and it is not supported on humanitarian,
medical or economic grounds.