The View From Your Sickbed

by Patrick Appel

A reader writes:

It was only last year that the The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 mandated that insurance companies treat mental illnesses with the same coverage as physical health. This was after a 12-year fight to get it through Congress, and after being wrapped up in tax cuts to make it more palatable to lawmakers. But for years and years, mental health care was even more disgraceful than physical health care, only less talked about. In yesterday's New Hampshire press conference, Obama responded to a question about mental health care in the current bill by saying that such care is "under valued" in the insurance market. The president said that serious depression is as bad as a broken leg, and that he wants a "mental health component" in the ultimate package.

I have had bipolar disorder ever since puberty.

When I'm off my medications, I will alternate spells of tearful anxiety fits with  depressive episodes of 14 hours of sleep, the inability to concentrate, and near-constant suicidal thoughts. When I was kicked out of college (the first time) for bad grades, I was turned down by several private insurers for my pre-existing condition. And when my dad changed jobs, I was left in the lurch again. I've seen close to 12 doctors about it in the past four years, and believe me, as hard as it is to find a primary care physician, it is even more difficult to find a therapist that you like, trust, can afford, and who can treat your condition. And when you have a mental illness, you often have to switch prescriptions, dosage, and cocktails until you find a mixture that works for you. Sometimes, pills will stop working for no good reason, and it takes a quality professional to realize it and pull you out of a tailspin that you thought was being treated. And I'm sure your readers can tell even more stories about being turned down for jobs, being denied coverage, being hospitalized, and struggling for decades through the red tape, secrecy, and shame.

I attribute the reason why I am now healthy, sane and well treated to how incredibly lucky I am. My time in the wilderness was only three years long, mostly because my parents could afford to pay for therapist and psychiatrist bills out of pocket. I'm still young, and largely healthy, so I responded well when finally treated. My access to quality treatment kept me from self-destructive behavior and self-medicating that bipolar patients are prone to, and the fact that my mother is a doctor keeps me from ever running out of medication. I also had the good fortune of having my nervous breakdown when the economy was still good, so now that twice-weekly therapist meetings have tapered down to monthly ones, the family finances can manage.

I'm back in school now, and it breaks my heart over and over again to see friends of mine with the same or similar conditions be denied insurance through their work or privately, be forced to meet with bad therapists, and go weeks without their pills because of gaps in the system. And it's all invisible to most onlookers. I'm open about my syndrome, mostly because I have to be, but I know I'm going to have trouble when I graduate two Mays from now, and have to go off student insurance and my parent's insurance. (I don't want my mother to have to commit prescription fraud, as well). And anybody who's been following the recent Salon series on the dearth of good mental health care in the military knows that untreated mental illness and addiction is a plague on society and on families.

Section 14 of the current bill mandates that mental health and substance abuse problems will be treated equally as any other physical problem, continuing the work of the 2008 bill. The Mental Health Liaison Group(MHLG) (which includes The American Psychological Association, The American Counseling Association, The American Psychiatric Association, and The National Association of Social Workers) signed off on the bill in July. And Obama's words yesterday are heartening, if vague. And I know that I'm being rather long-winded and lingering too much on personal history to make my point. But in the larger health care debate, I would be happy just to get mental illnesses and addictions to come to the table as legitimate diseases, not personal failings.