Introduction
As a teenager I was on drugs. My parents divorced when I was thirteen, which left me bitter, angry, and at times a bit reckless. With careful consideration, I turned to drugs. My mother knew what was going on and she encouraged it, hoping that maybe they would help curb some of my aggression. Sadly, a lot of my peers didn’t feel the same. When most of my friends found out I was using drugs, they began to shy away from me. People whispered words while walking on egg shells when I was around. Drugs mellowed me out, and I wasn’t as angry any longer, so why were my acquaintances now treating me with such caution? I should clarify my experience with drugs: as an adolescent I was prescribed and regularly took anti depressants.
According to the American Psychological Association, otherwise known as the APA (2005), 18% of people in the United States “suffer from a diagnosable mental disorder” and close to 10 million are children (p. 2). Of those enormous numbers, 30% fear the possible social rejection of admitting their illness and an alarming 20% are so frightful of stigma that they decline treatment. In my case, being treated for mild depression caused my friends to react to me differently. With the prevalence so high, it’s alarming that such a stigma could me attached to mental illness.
Mental illness is nothing new to our society. Looking back in history we see that mental disorders have defined many people and events. The Salem witches and King Charles VI of France were thought to be mentally ill (Durand, M. V. & Barlow D. H., 2003). More recently, we see cases of insanity depicted on television and in the movies. Lively and at times erratic characters, such as many of those played by Jack Nicholson, show the most extreme cases of insanity. While those portrayals are not the norm, they still conjure up and perpetuate a harsh stigma that sticks with those who suffer from mental illness.
Having a widespread and socially distorted view of the mentally ill can lead to discrimination in other areas, one of which is health care. According to statistics compiled by Hammer (2004), most insurance companies only cover five days of inpatient care per year (p. 2). Weigh the prior information against the fact that it takes 2-3 weeks to stabilize someone on many antidepressant medications, some of which require hospitalization (Giacomini, P. A., 2005). When insurance benefits run out, patients can either attempt to seek treatment in an overcrowded county institution or discontinue treatment, which is usually the case. The prognosis for many mental illnesses is not good and can often lead to behavior that makes patients a danger to themselves or to others.
Aside from the anxiety associated with seeking professional help for a mental disorder, it can be even more frustrating to deal with the sheer cost of treatment. In reality, the cost of providing greater health insurance to the mentally ill isn’t a great one.
Even so, when there are people suffering from cancer and leaving families financially destroyed, it is hard to focus on funding for the mentally ill. Keep in mind that mental illness is a physical illness and with it can come a variety of other health problems.
Sometimes it can be hard to see a mentally ill person acting irrationally and logically conclude that they suffer from a disease. When faced with a young, severely balding female, most people can come to the conclusion that she might have cancer. Seeing someone shuffling while they walk and constantly moving their jaw might appear as odd or eccentric behaviors, when in fact those characteristics are common side effects of some psychotropic drugs used to treat mental illness. It is not that society is rude or un-accepting of the mentally ill. I blame a lack of education for the reoccurring stigma that has attached itself to mental illness. Society easily influences opinion and only the most severe cases of mental illness make it to the headlines. It’s difficult for a reasonably sane person to see how a word such as “crazy” can have a negative connotation, as those words don’t personally affect them. Defining the mentally ill and their disorders as craziness causes the hurt, fear, and shame that enable stigma to survive.
Review of the Literature
It’s surprising that prejudice still surrounds mental illnesses. The American Psychological Association (APA) (2005), stated that approximately 18% of the population “suffer from a diagnosable mental disorder” (p. 2.) They also suggested that 1 in 10 Americans will develop a disability stemming from a mental disorder at some point in their life. The APA claimed that “many of these disorders are just as preventable, controllable, or curable as physical illness” (p. 1). Paul (2005), of Psychology Today, affirmed that “the line between normal and abnormal personality is much more subtle than anyone imagined” (p. 56). Mental illnesses are rather common. Paul continued, “Our conception of mental illness is due for a revision” (p. 56). It seems that with such a high prevalence society would be willing to accept mental illness and openly provide treatment for it. Sadly, that is not always the case.
The National Mental Health Informational Center (NMHIC) (2005) defined stigma as “a word that means branding and shame” (p. 1). According the NMHIC, stigma is responsible for hindering one’s ability to get “good jobs and [advance] in the workplace” (p. 1). Stigma is also a main reason for lack of treatment. The APA (2005) concluded that 30% of those that suffer from a mental illness are afraid to publicly admit their disorder and an alarming 20% fear public rejection so much that they refuse to seek proper treatment. How can a fairly common disorder have such a strong stigma attached to it?
Martin (2004), of the Sun-Herald, told the story of 28 year old Ruth Ann Burns who was convicted of murdering her seven year old daughter Hannah. The elder Burns had a serious history of schizophrenia and was shuffled in and out of mental hospitals. On the surface, many articles like this one paint a gruesome picture of what mentally ill people might be capable of. It’s easy to form a prejudice out of fear and misunderstanding. People suffering from a mental disorder do not want to be displayed as a front page headline on a newspaper; they do not want to be labeled ‘crazy.’ Therefore, many of them do not seek help.
Reading further into Martin’s article you would find that Hannah’s grandfather, John Burns, didn’t quite blame Ruth Ann for the death of his granddaughter. He told the Sun-Herald that “Hannah would be alive today if the mental health system had placed her mother in a long-term care hospital” (p. 1). Baker, who worked for the Department of Children and Family Services, commented to the Sun-Herald claiming that “the system was not to blame. Sometimes, it’s just a fact of the illness” (p. 1). Baker’s comments contributed to the belief that all mental patients have the unavoidable potential to be a danger to themselves or others.
In the case of Ruth Ann Burns, Martin (2005) reported that during a brief stay at a local residential facility, “a recommendation was made that [Ruth Ann] be placed in a state mental institution for a long-term stay” (p. 1). Why wasn’t this documented schizophrenic institutionalized as professionally suggested? How was it that Ruth Ann Burns was left untreated and allowed to cause harm to her seven year old daughter? The request for Burns’ confinement was denied due to a lack of available beds at the South Florida State Hospital, where long term patients are transferred. Christine Cauffield, who works in a treatment center for the mentally ill, admitted that the surrounding area is “woefully short of beds.” She explained, “Our occupancy rate was 101.5% last year” (p. 2).
The case of Ruth Ann Barns leaves one to wonder why hospitals are so over crowded. In the book Out of the Shadows, by Dr. Torrey (1997), the confusing situation of funding for the mentally ill comes into focus. Torrey brought to light the fact that “medicaid pays for psychiatric care in general hospitals but not in psychiatric hospitals” (p. 103). Torrey quoted research published by Kiesler and Simpkins saying, “over 60 percent of all psychiatric inpatient episodes take place in general hospitals” (p. 104). He went on to speculate that general hospitals were costing nearly $200/day more than psychiatric hospitals and the focus of patient needs shifted into a question of, “what will federal programs pay for?” (p. 105). So why are the majority of those receiving treatment being holed up in overcrowded county hospitals? Personal insurance coverage plays a major role in this.
According to Hammer, the President of the National Alliance for the Mentally Ill (NAMI) (2004), the typical insurance coverage for mental illness allowed for 5 days of inpatient care a year. However, evidence from notes complied by Giacomini (2005), suggested that it can take anywhere from 2-3 weeks for a patient to be stabilized on medication, which leaves an obvious gap between covered treatment and needed treatment.
Hammer (2004) compared the insurance coverage of the mentally ill to that of the physically ill and found it lacking. While mental illnesses received only 5 days of inpatient care per year, all other illnesses were allowed an unlimited amount of treatment. Hammer asserted that “mental illness is not a choice. People do not choose to be mentally ill” (p. 1). She also agreed that there is a certain shame and stigma that comes along with mental illness. Hammer isn’t shy about admitting her disdain of private medical insurance; she outright declares discrimination. Hammer isn’t alone in her desire to attain equal treatment. The APA (2005) devoted much of its efforts to defining mental illness and its effect on society. Even though insurance companies tend to separate the two, the APA reported the NIMH as stating that “mental health disorders often aggravate physical illness” (p. 4).
Argument
It’s easy to see how serious social stigma can be. It’s a cycle that has no real beginning and at this point, no real end. The untreated schizophrenic mother takes the life of her daughter and is viewed by the public as a classic mental patient. Society, including health insurance providers, view mental illness as something completely different than physical illness, stigmatizing it while discriminating with health care coverage. A lack of benefits results in people like Ruth Ann Burns not getting the treatment they need and deserve and thus the cycle continues.
This cycle is a vicious one that allows a lot of prejudice and unfair treatment. It is obvious that many people attach a stigma to the mentally ill, labeling them as psychotic or insane. The majority of society doesn’t see the similarities in physical and mental illnesses. For example, when someone lacks adequate white blood cells, people set up fund raisers and pot-lucks, yet when someone has an overactive production of dopamine, we tend to turn our heads away in horror. This lack of equation leads to those suffering from a mental disorder receiving considerably less care than those diagnosed with a physical disease. If society doesn’t recognize certain brain disorders as just illnesses, then why should insurance companies? If patients are left without medical coverage, they will be forced to cope with their mental illness on their own. Without treatment, the prognosis for a mentally ill patient is dismal and in some cases these untreated individuals cause harm to themselves or others only feeding into society’s already distorted image of the mentally ill. What are the underlying causes of this unfair cycle and how can we help abolish it?
It’s no surprise that this issue can hit close to home. Just about twenty percent of the U.S. population will experience some sort of mental illness during their life time. I vividly remember visiting my fifteen year old cousin in a county mental institution, even though her incarceration was nearly ten years ago. At the time, her plight for normalcy invoked in me some serious emotion and interest in the treatment of the mentally ill. This year I enrolled in an abnormal psychology class which took a look at the history of mental illness, and I was shocked at the horror I discovered. I was more disturbed by the realization that even with numerous medical advances, much hasn’t changed.
I spent a good portion of my adolescent years with my nose stuck in medical dictionaries. With the onset of my cousin’s illness, I began to question my own troubles and subsequently read as much as I could on mental illnesses. Last year I took an introduction to psychology class and gathered a good amount of basic information on how the mind works, which led me to believe that there are observable, physical causes of mental illness.
Because some people have a general misunderstanding of the mentally ill, it creates a social stigma that can hinder those suffering from seeking treatment and allows insurance providers to discriminate when it comes to health coverage.
Overall health shouldn’t simply be confined to the functionality of one’s vital organs. While the heart may be at risk when it’s overloaded with cholesterol, the brain can be at risk if it is producing too much or too little of a certain neurotransmitter. If insurance companies mean to exclude mental illness coverage in their plans, then perhaps they should consider revising the name to outward bodily appearance insurance. It seems as though society has been coerced into believing that someone must show physical symptoms to actually be ill and in need of treatment. Overall health should not simply be confined to the functionality of one’s vital organs. While the heart may be at risk when it’s overloaded with cholesterol, the brain can be at risk if it is producing too much or too little of a certain neurotransmitter. If insurance companies mean to exclude mental illness coverage in their plans, then perhaps they should consider revising the name to outward bodily appearance insurance. It seems as though society has been coerced into believing that someone must show physical symptoms to actually be ill and in need of treatment. Hammer (2004) is not only the president of NAMI, but she is also an admitted sufferer of a mental disorder. Aside from being an advocate for the mentally ill, she understands first hand the prejudice that comes along with having a mental disorder. As she confessed on paper to having a mental illness, she trembled, perspired, and had difficulty breathing. She blames her physical symptoms of anxiety on “the shame and stigma associated with mental illness” (p. 1).
Her disdain for the current lack of insurance coverage is evident as she writes as an advocate for the mentally ill. Her words called out the distinct lack of equation between mental and physical illness. She questioned why some brain disorders are met with sympathy and others with horror, such as Parkinson’s disease or Alzheimer’s. She continued, “People with these brain illnesses get good medical care, along with society’s compassion and understanding” (p. 1).
Hammer provided statistics that stated “80% of people with bipolar disorder recover with proper treatment. Over 80% of people treated for severe depression recover.” She goes on to conclude that the “rates for recovery from mental illness surpass the recovery or cure rates for many physical illness” (p.1).
Martin’s (2005) article chronicling Ruth Ann Barns’ mental disorder, lack of treatment, and subsequent conviction of murder, questioned whether or not there was adequate care available for the mentally ill. It is easy to ponder the fate of Hannah Burns had her mother been properly treated for her mental illness.
What it boils down to for most people is the cost of treatment. Health coverage as it is now is not cheap by any means, but it is a necessity. Including mental health coverage into insurance plans would mean an increase in premiums. What needs to be understood is that the positive benefits far out weigh the slight rise in cost.
Anyone who holds a job can clearly see the value in their coworkers. People showing up for work increases productivity and efficiency, but as the APA (2005) pointed out, “60% of employee absences were due to psychological problems” (p.1). That equaled out to roughly “$23 billion in lost work days each year” (p. 2). Simple math can show that it wouldn’t take 23 billion dollars to provide people with mental health coverage.
Creating equal heath coverage wouldn’t just be doing a service to the mentally ill; it would be benefiting all taxpayers and premium holders. It is cost effective to treat the mentally ill, rather than leave them uninsured. The APA asserted that “ending all discriminatory coverage for mental health services will save money for our health care system” (p. 7). According to evidence compiled by Coopers & Lybrand, out-of-pocket patient expenses would be reduced by the billions and private sector premiums would only rise about 3.2% (cited in APA, 7).
Eradicating the social stigma surrounding mental illness and health care is a long process that’s barely begun. The APA noted several states that have created health insurance parity. “Maryland, Minnesota, Maine, New Hampshire, and Rhode Island, among other states, have enacted laws that require that coverage for mental illness services be on par with services for physical health” (p. 7).
This is definitely a step in the right direction, but one of many ways stigma can be lessened and health insurance improved. I think the answer really lies in education. Informing the public about the diversity in mental illness can help build a better understanding. Society should take an interest in the illness that silently affects so many. With the prevalence so high, it is likely that mental illness will strike in the immediate family. Being prepared, aware, and properly insured can enable people to overcome or cope with their illnesses and live a less stigmatized life in society.
Giacomini, P. A. (2005, Spring). Abnormal psychology. Springfield: Springfield College in Illinois.
Hammer, C. (2004). We need equal treatment. Retrieved February 13, 2005, from http://www.athealth.com/Consumer/farticles/Hammer.html
Paul, A. M. (2005, March/April) Am I normal? Psychology Today, 54-60. Martin, G. (2004, June 14). Sometimes, an illness wins. Sun Herald. Retrieved February 27, 2005, from http://www.sun-herald.com
Nation Mental Health Information Center (2005, February 1). Before you label people, look at their contents. Retrieved February 1, 2005, from http://www.mentalhealth.org/publications/allpubs/SMA96-3118/default.asp
Torrey, E. F. (1997). New initiatives in funding. In Out of the Shadows (pp. 90-140). New York: John Wiley & Sons, Inc.