At a recent conference held in New York City, Rep. Richard A. Gephardt (D-Mo.), U.S. House Minority Leader, gave his first policy speech on mental health care in the United States. Deborah C. Peel, M.D., president of sponsoring organization the National Coalition of Mental Health Professionals and Consumers, noted that this was a historic event, adding that no elected official of his stature has spoken publicly on the importance of mental health care access and privacy. Gephardt addressed the group of clinicians, consumers and legislators as part of the coalition's conference to announce its new Inform America campaign, which will advocate for the three essential elements needed for real mental health care: real benefits (i.e., access to the right professional, at the right time, for the right treatment), real parity and real funding.
While noting that the United States has the best health care in the world, Gephardt added that there is still a lot of room for improvement, especially in mental health care. He stated, "We have come far in raising awareness of mental health issues, but we have not come far enough. Forty years ago, mental health was simply a non-issue in our public discussions and, for the most part, in our public policies." Acknowledging the work of the Coalition and other advocacy groups in garnering attention for mental health issues, Gephardt said, "Mental health is becoming a critical issue that is part of an ongoing discussion about quality of life and quality of care issues in America and around the world."
But he reminded attendees that such grassroots efforts were crucial to making significant changes. "You cannot expect that people in the Congress or even the President can magically turn these things around. It takes a movement. It takes citizen action to start the ball rolling down the road to...get the information out so that people feel differently about these illnesses and what can be done about them."
Gephardt stated that the next great challenge is removing the barriers to mental health care. He explained, "I believe that the entire nation needs to be educated that mental illnesses are just that--illnesses, with effective treatments available." He added that when the American public realizes that people who suffer from mental illness no more chose to be sick than those who have diabetes, they will insist on access to treatment for mental illness, just as they would for diabetes. He added, "One of the first things we need to figure out how to do is to never say 'mental health' anymore --- it's health."
Noting the significance of stigma as a barrier to ensuring care for all, Gephardt said that our government has already passed acts that protect against discrimination on the basis of disabilities, race or sexual orientation. "We've had a long history of being in the process of trying to think about people in the right way and change attitudes and hatreds and discriminatory behavior," he said. "We're making progress [so] don't give up, don't even be pessimistic When you look at other efforts that have fought discrimination and misunderstanding and ignorance, they are long-term efforts that have spurts of progress and then fall back and then more progress."
In addition to raising awareness, Gephardt emphasized that the federal government has the responsibility to ensure access to real mental health care for all Americans. Another barrier to mental health care is lack of patient privacy.
"As the Supreme Court affirmed in Jaffee v Redmond, without privacy guarantees, effective psychotherapy is simply not possible," he told attendees. "Before the privacy rule was implemented, we heard a lot of arguments against it. We heard that it would be expensive or inconvenient to safeguard the privacy of Americans' medical records. I say that privacy is so fundamental to ensuring access to medical care that it is well worth some inconvenience or expense to guarantee it to our citizens."
He outlined what Congress is doing to address this.
"The Senate is currently considering the Bipartisan Patient Protection Act of 2001. I am working with my colleagues in the House to ensure that we have the opportunity to vote on this important bill. I am proud that it provides protections for those with mental, as well as physical, illnesses."
He added that the bill requires a point-of-service option, direct access to specialty care for chronic conditions, continuity of care, access to clinical trials, age-appropriate care for children and legal remedies for those who have been injured.
Another roadblock to access comes in the form of managed care and insurance companies that may limit or deny access to proper care for mentally ill patients.
Gephardt explained, "Access to care is too often limited by insurance coverage... especially in managed care plans, access to mental health care is often subject to both direct and indirect limits, making it virtually impossible for people to receive the kind of quality care they need and deserve."
He added that one of the issues he struggles with is whether or not health care should be for-profit. He believes that the for-profit concept is inherently going to be in conflict with what needs to be done in the health care system.
Gephardt also addressed parity. He stressed that it is common sense that mental health care coverage should be at the same level as physical health care. "This is based on the knowledge that mental illnesses are exactly that: illnesses. And everyone must have insurance We must pass a number of bills to cover people in different circumstances."
With effort, Gephardt believes that these barriers can be eliminated and encouraged attendees, "We can do it, and we must do it. Mental health care can improve and even transform people's lives. We can reduce suffering, increase productivity and strengthen families. But we must ensure access."
He further acknowledged that mental health advocates have made huge steps in reaching this goal, adding, "I look forward to working with you to reach it once and for all."
