An Open Letter to Barack Obama

Dear Mr. President:

Congratulations on your recent victory. Now, as you plan the next four years, I'd like to offer a few suggestions on how you can help those of us living with mental illness. Fight for parity in mental health treatment, work to reform the fragmented mental health system, and attack the stigma behind mental illness.

Insurance companies and legal discrimination

In 2001, President Bush established the New Freedom Commission on Mental Health. According to the National Alliance on Mental Illness, in 2002 the Commission found three barriers to mental health treatment: stigma, a fragmented mental health services delivery system, and unfair treatment limitations and financial requirements placed by private insurance.

Insurance companies legally discriminate against people with severe mental illness, both by pre-existing clauses (which your Affordable Health Care Act will ban in 2014) and by offering different coverage for mental health than physical health. Even the Mental Health Parity Act of 1996 did not entirely alleviate the problem. According to the Centers for Medicare and Medicaid Services, the act prevents insurance companies from offering lower mental health benefits than physical health benefits—for example, if a health plan has a $1 million lifetime cap for medical and surgical benefits, it can not cap mental health benefits at $100,000. However, there is no prohibition against increasing co-pays or limiting visits, imposing limits on the number of covered visits even if there is no comparable limit in medical or surgical benefits, or having higher co-pays for mental benefits than physical or surgical benefits. In addition, if meeting the MHPA’s requirements would increase the employer’s costs by one percent or more, they are exempt. Employers with less than fifty employees are also exempt. In addition to this, there was no requirement mental health benefits were offered.

This is wrong and needs to be fixed. When one in four people in this country has been diagnosed with a mental illness at one point, it is irresponsible to put unfair treatment limitations on mental health treatment. Work with Congress in order to address this lack of parity. Close the loopholes. You may have to drag the insurance companies into the Twenty-First Century kicking and screaming, but it's the right thing to do.

"Fragmented and in disarray"

According to the New Freedom Commission on Mental Health, our mental health care delivery system is "fragmented and in disarray ... lead[ing] to unnecessary and costly disability, homelessness, school failure and incarceration." ". This fragmentation included gaps in care for children, gaps in care for adults with serious mental illness, high unemployment and disability for people with serious mental illness, lack of care for the elderly with mental illness, and lack of national priority for suicide prevention and mental health treatment. This needs reformed.

The gaps in care for children, adults such as myself who have serious mental illness, and the elderly are caused largely by insurance companies. There simply is no will to treat mental illness. It's not profitable. We need to offer incentives such as tax breaks to insurance companies that offer generous mental health benefits.

We need community-based treatment with the ultimate goal of recovery. We need to integrate research results into community-based treatment instead of institutions. We need incentives (such as student loan forgiveness) for mental health professionals who serve under-served populations. We need improved access to care, especially for those of us in poverty.

Stigma

The stigma to mental illness is so strong that a National Mental Health Association (NHMA) survey ranked it the number one barrier to treatment, according to a PRNewswire article. According to former U.S. Surgeon General Dr. David Satcher, nearly two-thirds of all people with diagnosable mental disorders do not seek treatment, in large part due to this stigma. Satcher wrote "Stigma leads others to avoid living, socializing or working with, renting to, or employing people with mental disorders, especially severe disorders such as schizophrenia. It reduces patients’ access to resources and opportunities (e.g., housing, jobs) and leads to low self-esteem, isolation and hopelessness. It deters the public from seeking, and wanting to pay for, care. … More tragically, it deprives people of their dignity and interferes with their full participation in society."

As an elected official, you have the power to speak out about this stigma. Former President George W. Bush tried to attack the stigma behind mental illness. He said "Americans must understand and send this message: mental disability is not a scandal - it is an illness. And like physical illness, it is treatable, especially when the treatment comes early." He's right. You can do the same by speaking openly and honestly about mental illness.

The future of mental health treatment is in your hands, Mr. President. I pray that you'll work for a better system.

Regards,

Becky Oberg