The US House of Representatives recently passed a bill that would require health insurance companies to cover mental illness.  Apparently, health insurance companies are none too pleased about the prospect of having to provide this coverage (for example, see NYT coverage).

This type of controversy really gets my blood boiling.  Consider the following questions raised:

“Is an ailment a legitimate disease if you can’t test for it? A culture tells the doctor the patient has strep throat. But if a patient says, ‘‘Doctor, I feel hopeless,’’ is that enough to justify a diagnosis of depression and health benefits to pay for treatment? How many therapy sessions are enough? If mental illness never ends, which is typically the case, how do you set a standard for coverage equal to that for physical ailments, many of which do end?”

First of all, many “physical” illnesses also lack a hard and fast test– there is no test to tell the doctor if you have a cold, or in many cases why some people have lower back pain, but in those cases, we expect treatment.  Second, psychiatric diagnosis does not stem from one complaint alone (e.g. “I feel hopeless”), but rather requires a systematic review of patient history, current symptoms, and other factors, just like going to the doctor for physical illness.  Third, while many mental illnesses are chronic, so are cardiovascular disease and cancer, but few people would suggest that just because a disease is chronic, insurance should not be required to cover it. Furthermore, treatment can vastly improve the lives of patients, and make them more functional and productive members of society.

Mental health and physical health are linked, and many so-called mental illnesses have distinct biological bases (genetic, neural).   If anything, I would argue that the fact that we do not understand the biological bases of mental illness provides justification to invest more in research and give more attention to treatment.  Furthermore, I would venture to guess that if we provided adequate mental health services to those in need, we might actually reduce the overall burden of healthcare costs (countries that provide universal health coverage to their citizens often cover mental health as well, because it is the smart thing to do).  As noted by the NYT: “a 2006 study in The New England Journal of Medicine, examining the costs associated with a parity program put into place by President Bill Clinton for all federal employees, found that it actually didn’t increase the use or the cost of mental health services.” 

In the long run, the United States needs to think about prioritizing the health of the population.  This means covering those who need coverage, and it means considering the person as a whole.