Second
Opinion: Writing Off Depression
By Abigail Trafford
Washington Post Staff Writer
Tuesday, January 1, 2002
A gentle holiday season this year, with bold sunny days, quiet family gatherings
and too much pecan pie. There is solace in the midst of war with the awakening
of the country's spirit and a new level of grace in the outpouring of generosity
and compassion after Sept. 11.
But Santa Claus has left a lump of coal this year for a large group of wounded
Americans. They are the millions of people with mental illness.
For starters, lawmakers left town without passing bipartisan legislation that
would cover psychiatric illness such as depression and post-traumatic stress
disorder on a par with diseases such as high blood pressure and diabetes. Too
expensive, said the grinches in Congress, despite studies estimating very small
increases in premium costs which would be offset by savings in emergency room
visits and hospital stays.
The legislation, limited to people with certain forms of private insurance,
would hardly fix the many problems in the patchwork of public and private
services needed by people with mental illness. But such a law demanding parity
in psychiatric care would have far-reaching symbolic influence on government
programs and private health plans to improve the treatment of mental illness.
Without a national commitment and government leadership, the current non-system
for providing mental health services continues to unravel.
In suburban Maryland, a man with schizophrenia is so anxious he does not dare
venture from his apartment to buy groceries or see his doctor. Because of state
cutbacks in mental health programs, he has just been told he will no longer be
eligible for services at a clinic that has helped him control his anxiety and
keep his doctor appointments. What will happen to him? "I'm at a
loss," said Cindy Ostrowski, program director of the clinic run by St.
Luke's Inc., a private nonprofit agency that provides a range of services to
adults with psychiatric disorders in Montgomery County. "It's just really
frightening."
A woman with severe bipolar depression is also losing her benefits at the
Maryland clinic. Three years ago, her depression was untreated. Her condition
was so disabling that she could not get out of bed. Then she entered a
psychiatric rehabilitation program at the clinic where counselors made sure that
she went to the doctor and took her medications. They also helped her gain
social skills so that she could live independently. She has made progress, but
without this supportive program to help her manage her illness, she is risk of
slipping backwards.
Meanwhile, an 18-year-old boy sits in a Maryland jail where he's attempted to
commit suicide several times. He is too disturbed to live at home but not sick
enough for hospitalization. He depends on medications, which are covered under
his mother's private insurance plan. But because he has private coverage, he is
not eligible for the public program that provides safe and supervised housing
for people with mental illness. He needs a psychiatric program that offers both
medication and residential support. Instead, he ends up on the streets and is
picked up by the police for aberrant behavior and sent to jail.
"The whole system is starting to implode," said Evelyn Burton of the
Montgomery County chapter of the National Alliance for the Mentally Ill.
"There is nowhere for these people to go."
In the District, a boy with post-traumatic stress disorder (PTSD) and attention
deficit/hyperactivity disorder was hospitalized five times in the last two years
before he was properly evaluated and treated. His mom had to stop work. She
could not find a psychiatrist to take his case or a day treatment program for
children in the city. Although she had private insurance, much of his care was
not covered.
Meanwhile at St. Elizabeths, the District's psychiatric facility, federal
regulators recently found major abuses of patients and deficiencies in care.
The collapse of mental health services is ironic in the wake of Sept. 11. The
terror attacks and risk of future assaults have made everyone aware of the
importance of mental health and the need for quality services.
Businesses have called in psychologists and social workers to help their
employees deal with anxiety. The media have publicized warning signs of PTSD and
offered stress-reducing tips. In New York, the police are undergoing mandatory
counseling. Public service posters feature such messages as "Even Heroes
Need to Talk" and "Feeling Anxious after 9/11 Is Normal."
But that kind of support disappears for the rank-and-file mentally ill. This is
the difference between a politically correct illness related to the September
attacks and a socially stigmatized mental illness.
Perhaps Sept. 11 can help change the dialogue. After the attacks, the editors of
the New England Journal of Medicine laid out the mission for physicians in a
kind of post-9/11 Hippocratic oath:
"We must act on the core value of our profession: healing. We must console
and counsel those who escaped death and the families of those who were killed.
It is essential to ensure for them the immediate availability of necessary and
appropriate psychiatric or psychological counseling. Children will have special
needs . . . .
"Victims and their families must receive medical and mental health
attention regardless of their ability to pay and whether or not they have
medical insurance," continued the editors.
Well said. But why not include those who suffer from the devastating
consequences of disorders of the mind, whose origins may not lie in a national
disaster? While the roots of mental illness are found in a complex formula of
personal trauma, genetics, environment and mystery, the suffering is universal.
Americans are racing to see "A Beautiful Mind," a movie about a Nobel
prize-winner who suffers from schizophrenia. Meanwhile, their national leaders
are racing away from meeting the needs of people with disorders like his.
My public New Year's resolution: make the post-9/11 Hippocratic oath apply to
all Americans, regardless of how they developed mental illness.
~~~~~~~~~~~~~~~~~
Editors note: This is a divided issue, psychiatric survivors
and the anti-psychiatry groups are concerned that parity legislation will
support the pharmaceutical industry and conventional management of mental
illness with medications. The Citizens Commission on Human Rights
has issued a report with this viewpoint: CCHR
Report.
