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May 18, 2000, Thursday

SECTION: PREPARED TESTIMONY

LENGTH: 1065 words

HEADLINE: PREPARED TESTIMONY BY KEN DUCKWORTH, M.D. DEPUTY COMMISSIONER MASSACHUSETTS DEPARTMENT OF MENTAL HEALTH BOSTON, MASSACHUSETTS

BEFORE THE SENATE COMMITTEE ON HEALTH, EDUCATION, LABOR AND PENSIONS

SUBJECT - MENTAL HEALTH PARITY

BODY:
Mr. Chairman, Senator Kennedy. and members of the Health, Education, Labor and Pensions Committee:

I am here to testify in strong support of full parity for serious psychiatric illness such as would be advanced under the Mental Health Equitable Treatment Act (S. 796) introduced by Senators Domenici and Wellstone.

As a clinical psychiatrist in an academic community mental health center for 13 years, I have seen the negative effects of insurance discrimination on people with catastrophic psychiatric conditions, and how this bias contrasts with other illnesses. Full parity redresses a number of inequities that are arbitrarily imposed on people because of their illness "status", and does so at minimal, to no cost.

This action is warranted at this time, as our neuroscience knowledge base has expanded dramatically in the past two decades helping us, as a field, to better understand the underpinnings of disorders of the brain. At the same time, our profession has come to understand that people require cost-effective services - those that produce the best outcomes for the scarce resources utilized. This pressure towards accountability, has fortunately intensified uses of alternatives to expensive hospitalization, and has increased training efforts to get people back in to the workforce as quickly as possible during their treatment. This professional change is important, as brain disorders are a substantial, and growing cause of disability and lost workdays in the United States. I have witnessed the discrimination that full parity redresses personally, as well professionally. As a family man with three children, I faced a catastrophic and potentially life threatening illness. This illness was cancer- the response I received in our society was of support and encouragement. Not surprisingly, my insurance coverage mirrored this view of my illness as "legitimate". Over $250,000 was spent on my chemotherapy and surgeries, with minimal cost to myself. I was, and am, very grateful for a medical system that helped me to live and to do so with dignity and without catastrophic financial loss.

Yet another family man with three children I know had a different kind of illness bipolar, also known as manic-depressive illness- and received a very different response both from society and the insurance industry. I know this story intimately, as that family man is my father. His illness isn't based in the immune system as was mine; it is based in his brain. Yet this minor biologic difference resulted in grossly different treatment by friends, church members and, notably, the insurance industry. During my childhood, his condition was never talked of openly; his problems were presumed to be of his own making. Indeed, people acted like this neurochemical deficit was almost contagious. These fearful attitudes were reflected in his insurance policy, which did not cover him in any way as I had been. For my father, this discrimination resulted in lost days of productivity, financial loss and unnecessary human suffering.Full panty is therefore the logical extension of our increased knowledge base about catastrophic brain disorders that afflict children, adolescents, and adults. My experience as a clinician teaches me that people's fears and attitudes about people with these brain disorders lags behind our understanding of these conditions by several decades. In a 1998 survey that I designed involving 400 randomly selected Massachusetts residents, 2 out of 3 people questioned thought schizophrenia was the same as "split personality" - it is not. Additionally, 90% agreed with the statement that, "because of shame, people do not seek help for psychiatric conditions." The respondents consistently felt they were more likely to seek help for a less stigmatized condition, such as heart disease. These kinds of misunderstandings and attitudes fuel the stigma associated with psychiatric illness. This stigma causes people to delay seeking help, which worsens their long-term prognosis, and increases the days they cannot function as effective workers: family members, and citizens.

Insurance policies that create barriers to accessing these services compound and reinforce these negative and skewed social attitudes. By legislating protections for these conditions as worthy of the same status as other biologic conditions, such as diabetes or cancer, we, as a society, legitimize the chance that the clinically depressed executive will get the help he needs to return to his former level of functioning in a briefer period of time, or that the suicidal 12-year- old will have easy access to a clinical assessment.

Dr. David Satcher, our Surgeon General, has identified suicide as a growing and important public health crisis. He is the first Surgeon General to do so, and his report makes the connection that the vast majority of suicides occur in the context of psychiatric illnesses. As a clinician, my experience is that the suffering that attends a suicide lasts for a lifetime for those left behind. This bill is one important step towards ending discrimination towards people with the conditions most likely to result in suicide.

In my State of Massachusetts, a mental health parity bill was recently signed after years of debate and struggle. Like 30 other states, the Legislators of Massachusetts correctly recognized the fundamental discrimination inherent in current widespread ins cc practice, and corrected it. This is something that we as a mental health field intend to carry out in a cost-effective way, as we have done for the Massachusetts State employees who have enjoyed this benefit for years prior to the statewide bill recently enacted. Yet many states have no protection for people with biologically based brain disorders. Voluntary efforts by individual businesses to improve mental health access and coverage are laudatory but fail to ensure a floor of protection for America's workers, who rarely work with one employer for their entire career. Full parity at the federal level ensures equal coverage across all places of work for people who suffer with these challenging conditions.

My experience as a doctor, patient and family member corroborates what the neuroscience and cost data reveal: Full parity is just, affordable and will make a difference for millions of Americans and their families. Thank you.

END

LOAD-DATE: May 19, 2000

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