藏精阁

By Rosalynn Carter

The Atlanta Journal and Constitution

When I was a child growing up in Plains, there was a young man in our community who was in and out of the state mental institution. When I heard him singing loudly as he came down the street, I would run and hide. I now know that he probably wanted nothing more than friendship and recognition. Yet, he was "different," and when I heard him, my impulse was to flee.

My understanding of mental illness and mental health has grown since I was that small child, just as mental illness is now better understood by professionals in the field and by medical science. I began my work as an advocate for people with emotional and mental illnesses when I was first lady of Georgia. On site visits, I saw the inadequate care people were receiving in large, overcrowded state mental hospitals and began to try to help get more humane and effective community-based care and more resources for treatment and research.

I came to realize that the great stigma against people with mental illness in our society, a stigma blind to the genuine suffering of many, held back progress in all I was trying to do.

Today, I feel we are fighting the same myths and stereotypes we were fighting 20 years ago. My greatest fear is that stigma will undermine the unprecedented opportunity we now have to finally eliminate the historic discrimination against mental illness in our nation's health-care system.

People such as the young man in Plains now can be treated and become contributing citizens in our communities. But many still believe that what is called mental illness is just a weakness or the result of bad parenting and that those suffering from it should assume responsibility for themselves, develop some strength and take charge of their lives. The fact is that we now know that many of the major mental disorders are clearly related to disturbances of brain chemistry.

These are definable and treatable illnesses, like physical illness. Clinicians agree on a given diagnosis for mental illnesses 80 percent of the time. Yet people from all sectors of society continue to believe that mental illness is a vague concept.

Whether with medication and/or other therapies, many mental illnesses can be treated as effectively or better than some physical illnesses. For instance, the efficacy rate for the treatment of manic depression is 80 percent and for the treatment of acute episodes of schizophrenia, 60 percent. But for angioplasty, it's only 41 percent.

From the time I was a governor's wife, I have seen great progress in the knowledge of the brain and the development of new medications. Many new combinations of medication and psychosocial services are being employed to effectively care for people with mental illness and dramatically improve their lives.

It appears the major concern among politicians is that health-care reform containing generous benefits will "break the bank," because many more people might seek treatment or continue with unnecessary treatment. Therefore, proposals are calling for arbitrary limits on how many times someone can receive a service and what percentage of the costs will be covered.

But studies of generous benefit plans show that there is not a groundswell of people demanding services or large numbers of people who seek therapy for years without good cause. The direct cost of treatment for mental illness averages $60 billion a year, or 10 percent of total U.S. health-care costs. But the cost of not treating mental illness is far greater. The indirect costs to our society in lost productivity and wages and strains on the welfare and criminal justice systems are three times more than those of direct treatment. Add to that the plight of many who are homeless on the streets of our cities.

There is also a growing body of evidence that effective mental health treatments can save money by reducing the use of other health services. One Medicare study showed that retirees' use of counseling services was followed by a 15 percent to 20 percent reduction in physical health-care costs. The link between mind and body in health care is corroborated not only by this study, but also by medical research.

High co-payments (50 percent) being proposed would effectively exclude thousands of citizens from outpatient psychotherapy. Yet therapy can be effective in preventing the development of more serious illnesses, requiring extensive and expensive hospital care. These high costs can be avoided.

Arbitrary limits on how much of a particular service will be covered also are of serious concern. Imagine the consequences of limiting treatment to a loved one who may be experiencing a severe mental illness, when the course of treatment has not been completed. Our system treats people with physical illnesses until they are well. Would we think it fair to have a limit of, say, a dozen radiation treatments for cancer, no matter how serious the condition? And if a loved one were mentally ill today, would we want to wait until the year 2001, as a proposed phase-in of mental health coverage would require, for that person to be able to receive the fullest range of treatment possible?

The health security plan of the administration offers some significant steps forward for mental health care. Proposals to abolish lifetime limits on mental illness, prohibit the exclusion of coverage for pre-existing conditions, offer universal coverage and include mental health screening as part of preventive health care will provide intervention and treatment to many who could not obtain it in the past.

Still, these measures offer only a partial solution to the needs of those who suffer. This may be the last chance for many generations to eliminate discrimination in the health-care system against people with mental illness. We can't afford to lose this opportunity.

Former first lady Rosalynn Carter was active honorary chairwoman of the President's Commission on Mental Health from 1977 to 1978. She currently chairs the Mental Health Task Force at the Carter Center. She will host the ninth annual Rosalynn Carter Symposium on Mental Health Policy at the center on Monday and Tuesday.