PsychSense: Sensible Psychological Solutions

Well the mental health parity laws are again in the news. Should insurance companies be required to give equal coverage for psychiatric illness as they do for physical illness? Here’s the rub, no one can agree on what a psychiatric illness is.

Most (but not all) will agree that a person with Schizophrenia has a psychiatric illness (a severe one at that) But what about Substance abuse? Is this a psychiatric illness or a behavioral problem?

Ok what is the difference between Psychiatric and Behavioral? Behavioral became the preferred jargon to replace psychiatric when the HMOs came into vogue. In my humble opinion, calling a psychiatric illness “behavioral”, puts the expectation on the patient to fix it (change their behavior.) Oh the power of words!

I never liked the “behavioral” word, but I too felt pressured to use it in the title of my own book Behavioral First Aid because it was the jargon of the day. I really wanted title the book Psychological First Aid but copped out because Behavioral was more accepted at the time. (This actually may be changing again.)

Ok, so the question now becomes which psychiatic Illnesses should be recognized as ones that cannot be controlled by the patient. I think for the most part this is pretty clear with illness like Schizophrenia. But what about depression? To be painfully honest, I am pretty tired of trying to convince people that clinical depression is VERY different then what many people call depression ( and take medicine for) like stress, grief and just normal downs of life. Clinical depression has many physical signs and symptoms and people cannot talk themselves out of it. With a major Clinical depression patients can be psychotic (out of touch with reality) More about all of this in future posts.

What about Bi-Polar illness ( the diagnosis de jure). Don’t get me started on that!

For today lets just have a reasonable informed discussion about mental health parity. I know the insurance companies cannot (and should not) pay for years of therapy for someone who has made no attempts to change the things they can, and uses therapy as a cruch. (granted this is a tough call but I believe we can do it).

People with major mental illness need and deserve insurance coverage. It is the responsibility of the professional community ( not insurance companies ) to draw these lines no matter how difficult it is. Mental health professionals of all disciplines need to put their own interests aside to band together and come up with a logical solution to this long standing issue.