The Mental Illness Stigma That Won’t Die

by Bill Brenner on May 18, 2010

The author came clean about his own battles with mental illness and addiction exactly because of stupidity like this…

Mood music for this post: “Push Comes to Shove” by Van Halen, from the “Fair Warning” album:


Kay Lazar from The Boston Globe wrote a story this week that sent my blood boiling. My problem wasn’t with the reporting or writing. She does a fine job. It’s the topic that burns.

The story, available here, is about firms putting limits on coverage for mental health care. It’s the same sorry song that ratchets up the fear level for those suffering from depression, OCD, bipolar disorder and the like.

It proves to the sufferer that mental illness is still viewed as a less-than-legitimate illness, something that’s more a figment of the sufferer’s imagination.

In the eyes of many health insurers, it appears this sort of thing doesn’t justify the same kind of coverage it offers for those with heart problems or asthma.

The industry can be just as daft when it comes to fair coverage of those things, too, but I look at mental health issues differently than most, given my own experiences. [Summed up in OCD Christmas, The Bad Pill Kept Me From The Good Pill and The Most Uncool Addiction]

Here’s the intro to Kay’s report:

Spiraling medical costs have driven many employers to place new limits on coverage for mental health care, raising concerns that the rules may violate federal regulations intended to make it as easy for patients to see therapists as other doctors.

At issue is the growing practice of requiring therapists to undergo lengthy and repeated phone interviews about their patients’ progress before the insurance company will approve further treatment. According to patients and therapists interviewed by the Globe, the reviews have established tougher criteria for additional visits and have been burdensome and intimidating. That has sometimes led to curtailed treatment and protracted appeals.

Among those feeling the squeeze are state and municipal employees who get their insurance through the Group Insurance Commission, a quasi-state agency that provides mental health coverage for more than 100,000 workers and their families.

The commission, facing double-digit increases in its mental health insurance costs, changed its rules last year and now requires therapists who are not in the commission’s roster of approved specialists to justify, usually through lengthy telephone reviews, a patient’s need for continued treatment after every 10 sessions. Previously, the commission simply required the therapists to regularly fax the insurer a progress report.

I would be simple to point the finger at one party and say they’re evil. Truth is, this is a mess that’s splattered all over the place. I think most employers want to do the right thing and offer the best coverage possible, but when costs spiral out of control they sometimes make decisions that prevent the mentally ill from getting the right treatment.

It’s especially easy to say the health insurance industry is the devil in this tale. After all, it’s the one making this outrageous demand for lengthy phone interviews before approving further treatment.

But I’m biased. My view of the health insurance industry is that decisions are based exclusively on the bottom line than on what’s right. I see it all the time. I also take the simple and probably naive view that if a sizable chunk of one’s salary is being used to pay for healthcare and all the extra expenses that come with medication, the insurer has no business putting the squeeze on patients.

I’m not an expert. I can only base my opinion on personal experience. But I’ve heard enough horror stories from other people to know this crap is for real.

That’s exactly why I started this blog.

I chose to out myself and share my experiences so other sufferers might realize they are not freaks and that they have a legitimate, very easily explained medical problem that’s very treatable. It takes that kind of understanding for someone to get up and get help.

I try not to engage in political debate because this is such a personal issue, though sometimes I have to make a point on current events like I did when Health care Reform passed in March.

I do know this, though: Many good people have died because of mental illness. They were ashamed and afraid to get help because of the stupid notion that they are somehow crazy and either need their ass kicked or be institutionalized. So they try to go it alone and either end up committing suicide because their brains are knocked so far off their axis or they die from other diseases that develop when the depression forces the sufferer into excessive eating, drinking, starvation, drug taking or a combination of these things.

There’s also the ridiculous idea that a person’s workmanship becomes valueless when they’re in a depression. If someone misses work because they have cancer, they are off fighting a brave battle. They are fighting a brave battle, of course. No doubt about it.

But depression? That person is slacking off and no longer performing.

I’ve been able to debunk that idea in my own work circle. It helps that I’ve been blessed to work with exceptional, amazing and enlightened people.

Luckily for me, I got rid of my fear and anxiety long ago, so I’m going to keep sharing my experiences. It probably won’t force change  or tear down the stigma single-handedly.

But if a few more people get just a little more fight in them after reading these diaries, it will have been well worth the risks.

{ 3 comments… read them below or add one }

Ben Jolley August 2, 2011 at 6:25 am

Great post and great song to accompany it. Limiting access to needed resources for mental health patients will ultimately cause more health issues and could include possible hospitalization. In the long run do health plans really save that much money?

Mary August 5, 2011 at 2:16 am

Why not limit Cancer treatment?
A single voice, is joined by others! I’m with you on this track!

Melinda S.Warner, Ed.D., ABPdN October 16, 2012 at 8:54 am

Speaking as both a mental health services provider – a psychologist – and a patient, I can tell you that the other way the Health Insurance industry is limiting people’s access to their mental health insurance benefits is by cutting the reimbursements to mental health providers. When the amount of money a clinician gets paid to see you drops by (just as an example) say – half – then eventually, they stop taking your insurance. I get lots of phone calls from people who are trying to find someone – anyone! – who will see their child with their insurance. More and more often I hear peers saying that they no longer take insurance X because it only pays them $17 per hour or some other outrageously small amount of money. Getting harder and harder to use your insurance! I thank god that I have been lucky enough to connect with therapists who have stuck with me in spite of mine.

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