The Ethics of Insurance Coverage: Mental Health

By: Leah McCaskill

Within a single week several people close to me have disclosed that they realized their insurance plans don’t include mental health benefits. One disclosure was comprised of a simple realization that his family had not selected a plan that includes mental health coverage. The situations of several others were more unsettling, because their insurance plans (provided through their employers) dropped mental health benefits. This is a shocking and upsetting development. I believe this is a sign of a larger phenomenon in play – one in which we collectively devalue mental health and delude ourselves into believing that mental states have nothing to do with physical states.

Meet Amy

Another close friend (let’s call her Amy) informed me that her new insurance policy includes a measly 3 consultation phone calls per year. That is, without a doubt, not enough mental health coverage. Therapists need time to develop rapport with patients. A greater deal goes into mental health recovery than a phone call to a stranger you can’t see. I was given the option to review a pamphlet given to Amy, which details this new three-consultation-calls-per-year plan. It was dismal. No information regarding the qualifications of the consultants, nor how long the phone calls would last, was provided. Supposing these consultation calls were taken by doctoral-level clinical professionals and held for several hours, it would not be enough for significant improvement. This woman was in severe distress. She needed her mental benefits. She had previously been seeing a therapist and would have to stop. This is unacceptable.

What Stigma?

In my experience, there appears to be a general lack of concern for the health of our mental states, and I believe this attitude is linked to dismal prospects for many people’s lack of mental health benefits. There are individuals I have known to openly mock and deride therapeutic services. It often seems as if people reject the notion that any mental/behavioral problem is worthy of focus or rehabilitation. It’s treated as a trivial nuisance in comparison to obviously physical problems such as cancer or broken bones. This ignorant attitude is what created the need for the The Mental Health Parity and Addiction Equity Act (MHPAEA). This act was utilized to prevent health insurance issuers from unfairly limiting benefits to mental health in relation to other medical benefits. Within the attitude that leads insurance companies and individuals to devalue mental health is another fallacy, which persists to this day: dualism.

Mind-Body Dualism

Mind-body dualism is the notion that our minds and bodies are distinctly separate entities. This view is archaic and has been debunked in a multitude of ways. We now know about the way the “mind” is linked to the “brain,” but there’s more to it. The brain is one part of the whole nervous system, which runs throughout the entire body. In addition, emotions have physiological ties. A racing heart, sweating, and breathing-rate changes have connections to emotions such as joy, fear, anger, etc. Our cognition (thoughts) can trigger physiological, hormonal, and other chemical reactions in our body. For example, the belief of lurking danger nearby may induce fear and the circulation of adrenaline throughout the body. Our “feelings” are not limited to our brains. The entire body is involved in emotional states. What many people consider to be the “mind,” and/or “soul” is inseparable from the physical body.

The Truth

Our behavior, cognition, and emotional states can affect our health. Emotional, environmental, and cognitive states (and environmental ones) that increase stress may increase immunosuppression (Ader and Cohen, 1975). Behaviors have more evident links to disease. Lack of proper hygiene, smoking cigarettes, drug-use, eating habits, and other actions have obvious links to physical health. Common problems often categorized under mental health include substance abuse, suicidality, eating disorders, and more. These are not minor problems. These issues can be deadly at worst and interfere with one’s life at best. Work, relationships, and general life function can become compromised due to the burden of mental/behavioral illness. Mental health services can be utilized to prevent and eliminate emotions, cognition, behaviors, and environments that deteriorate health.

A Mechanical Analogy

There is another important consideration to be made. Prevention services are also vital to any field including mental health. Car maintenance is a great analogy. It would be foolish to forego important maintenance and upkeep on one’s own car. Changing the oil, tires, and timing belt are a few important tasks to undertake in a preventative manner to conserve one’s car. Running the tires until they burst may lead to rim damage. Keeping the timing belt until it breaks could devastate the engine – rendering the whole car totaled. We take care of these before things hit rock-bottom to save money and the integrity of our cars in the long-run. Similarly, mental health is an important state to maintain using preventative measures before reaching rock-bottom. It is advisable to seek help for addiction before losing your job, or worse, experiencing an overdose. Eating habits should be checked before experiencing a heart attack or nutritional deficiency. Depression must be handled before losing a job or acting out self-harm. Mental health should never be a last-ditch effort when things have become hopeless. Prevention is about maintaining hope and function before irreversible or colossal damage occurs.

We must retire the notion of the duality of mind and body. The reality is that they are connected in many ways many of us fail to consider. If one values physical health, then one must also value mental health. It’s time for everyone, including insurance companies, individuals, and employers to show mental health the respect it deserves. It is the ethical and rational thing to do.

If you have any questions about your mental health benefits and are seeking therapeutic or psychiatric services, give us a call at (469) 714-0006 to reach our office in McKinney, TX. Exult Healthcare also offers services in Sherman, TX.

References:

Ader, R., & Cohen, N. (1975). Behaviorally conditioned immuno-suppression. Psychosomatic Medicine, 37, 333–340.

Mehta, N. (2011). Mind-body dualism: A critique from a health perspective. Mens Sana Monographs, 9(1), 202. doi:10.4103/0973-1229.77436

MHPAEA Factsheet. (2016, October 27). Retrieved August 25, 2017, from https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html

Written By: Leah McCaskill

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