Coping with a serious mental health issue, says Victoria Cain, is expensive. "There are some years, I think back on our income taxes, it was again tens of thousands of dollars even with insurance."
Cain lives with bipolar disorder. She has not had an episode in four years, but it took more than two decades of undergoing therapy and finding the right balance of medications to manage the disorder. "It's been a long, long road," she says. Even with insurance, all the co-pays add up for visits with physicians, for visits with therapists, for medications. Though Cain says she's "not real political," she wrote a letter to the Alibi about one measure making its way through Congress that she follows closely.
It's called the mental health parity bill, and it requires insurance companies to offer equal coverage for mental health issues as they do for other medical concerns. Under current law, insurance companies can't impose annual or lifetime limits on mental health care coverage, but they can choose to cover smaller portions of mental health bills than other medical expenses.
Versions of a mental health parity law have been attempted over the years, but backers thought 2008 was the year it would succeed. Though there was plenty of bipartisan support for the legislation in Congress, the bill stalled in the Senate. Advocates might resume efforts after Labor Day. "It hasn't been scheduled yet on the Congressional calendar, so there's no telling when it will come up," says Hannah VanderBush, spokesperson for Sen. Pete Domenici's office.
Mental health parity was attached to a tax package in the Senate, and among the major sticking points is figuring out how to pay for it. VanderBush says once that hurdle is jumped, the measure will need to be separated from the tax package and moved as a standalone bill.
New Mexico Republican Domenici joined forces with Sen. Edward Kennedy (D-Mass.) and Sen. Mike Enzi (R-Wyo.) to negotiate a parity agreement between health care, business and insurance. The bill made it through the Senate in 2007. "It is a matter of simple fairness," Domenici said in a news release at the time. He also estimated such a measure would help more than 113 million people. About 478,000 New Mexicans would benefit from the legislation, VanderBush says. According to a Wall Street Journal article, the bill would cost the government about $1.3 billion over the course of five years due to lost tax revenue.
"It's not right that a medical condition such as a brain imbalance—a brain chemistry imbalance, even structural imbalance—can be so ignored."
"I feel very strongly about it," says Cain, and she doesn't hesitate to call the insurance disparity discrimination. "It's not right that a medical condition such as a brain imbalance—a brain chemistry imbalance, even structural imbalance—can be so ignored."
Cain says it's hard to recover from depressive disorders, especially without proper health care. When Cain was graduating from college, she had her third psychotic episode and decided something was seriously wrong. She's been diagnosed as a "rapid cycler," which means she had more than one episode in a year, and sometimes several in a month. "And it was hell. What it's like is hell, because all your dreams, all your ambitions, all your skills and talents get totally shoved aside while you're trying to cope with the symptoms," she says. "There's a lot of disillusionment and a lot of grieving that goes on, because I knew that I was a capable person, but the symptoms of either mania or depression would incapacitate me.
She moved to Albuquerque from Santa Fe and went through UNM Hospital's mental health programs. When she sought therapy of any kind to resolve issues from her past or to learn coping skills, she paid out of pocket. She wasn't able to manage her disorder at the time and so couldn't work. When she finally got disability, she used that money to cover her therapy sessions. But she was lucky, she says, because she didn't have to get pre-authorization from her physician to see a mental health professional, which is rare.
Being manic and psychotic is scary, she says. "You feel out of control." But she managed that part of the cycle earlier on than the depression. "With medication and learning what the precursors to a full-blown manic episode were, I could prevent them by using medication and paying attention," she says. Finding the triggers for the downswing was more challenging. "I'm someone who had sometimes three months in bed with depression. That's not necessarily common. But there's a lot of people out there that do have that kind of depression."
Many can't afford to pay the high mental health co-pays and so seek help from their primary care physicians, Cain says. "They don't necessarily have training in psychiatric issues. So they might prescribe a medication that is maybe not the best for that person."
Cain says she thinks the fear on the insurance industry's part is that lots of people are depressed and it will be difficult to pay those bills, or that people will become "therapy junkies." But VanderBush points out that in the more than 12 years that Domenici's been plugging away the issue, he's been working with insurance companies to come up with an amenable solution.
Many people suffering from mental health disorders don't seek help, Cain says, because of the cost, denial or stigma. That stigma's slowly lifting, she adds, but it still exists. It affects relationships, Cain says. These days she works full-time, and she wonders if her coworkers will read this story. "I don't care, though," she says. "It's important for the word to get out that the people who have these illnesses can recover and can have full lives."