Healthy minds

Diseases of the brain need the same care -- and coverage -- as diseases of the body

Earlier this month Taunton Gazette publisher J. Timothy Hogan mysteriously disappeared. Four days later, he was found in some woods near his home, dead in his parked truck. He had taken his own life, leaving behind a suicide note that lashed out at the health care system. "I have this tremendous depression," he wrote. "So why not get help? I tried and tried and tried. The health system completely failed me."

Although the precise details of the Hogan case remain unclear, his story is telling. Diseases of the mind have always been viewed with some suspicion. The days are now gone when the mentally ill were suspected of demonic possession. Yet a heavy stigma remains: those who suffer are reluctant to look for help, and when they do, they may find that they don't have the insurance they need to pay for it.

A bill before the Massachusetts House would take an important step toward fixing that. Called "mental health parity," the legislation would require health insurers to provide benefits for adults with "serious mental illness" and children with "serious emotional disturbance." No longer would insurers be able to discriminate by arbitrarily setting lower monetary caps for covering biological disorders of the brain than they do for covering biological disorders of the body. (The bill would also mandate some coverage of addiction.) Already, the bill has unanimously passed the Senate. Governor Cellucci came out strongly for it earlier this month.

Mental illness is, of course, a widespread problem. According to the National Mental Health Association, 20 million Americans suffer from phobias; 4 million have obsessive-compulsive disorders; some 2 million have panic disorders; another 2 million have bipolar disorders. Seventeen million Americans struggle with the debilitating effects of clinical depression. Untreated, such diseases don't burden just the victims; they cost society. A 1995 study by MIT's Sloan School of Management, for example, estimated that clinical depression alone costs businesses $28.8 billion annually in lost productivity.

Yet Massachusetts has been slow to respond. We are now the only state in New England that has not passed a mental health parity law. All told, 18 other states have passed similar laws. The Massachusetts proposal would not be expensive: an actuarial study by Coopers and Lybrand estimates the total cost at $2.72 per policy per month. Everywhere the laws have been passed, the effects have been the same: a decrease in suffering, at a relatively modest cost.

The bill that now sits in the House, laudable though it is, is far from perfect. It does not do enough to protect the confidentiality of patient records. And it covers only the most serious problems. More important, like other "parity" laws, it does not solve the fundamental problem of access. Those who do not have health insurance are still not covered.

We live in a time of enormous scientific progress. Every year, researchers move closer to understanding why the brain breaks down. Every year, treatments grow more effective. Boston, with its premier universities and hospitals, has been among the leaders.

But Boston was also home to Dorothea Dix, the woman who more than a century ago started the nationwide movement to treat the mentally ill rather than abandon them to jails. She understood that scientific advances meant little without accompanying social advances. The challenge now, as then, is to find a way to get people like Hogan the comprehensive help they need -- and deserve.

What do you think? Send an e-mail to letters[a]phx.com.