Educating Media & Legislators
The psychiatric industry seeks to educate unsuspecting media, legislators and the public at large of scientific facts that are not even recognized as truth in the medical communitynot to mention the necessity for drug treatment and for insurance to pay for it all.
For instance, NAMI offers its members items like a Science and Treatment Kit designed to help them deliver strong and convincing arguments about the nature of mental illness and treatment.
Members are repeatedly urged to stop using the term mental illness but to use terms that acknowledge biology such as neurobiological disorders (NBD).
In instructions to NAMI chapters on how to write local newsletters, writers/editors are advised to sound like an insider. Use phrases like knowledgeable advocates know.
In addition to exhorting members to influence the media and legislators with their message, the literature dictates that [h]ealth insurance executives are also an important business audience because they play a pivotal role in shaping the extent of coverage for mental disorders.
At the top of the list of examples of how to pitch the campaign to the different audiences: blame acts of violence by psychiatric patients on politicians who failed to invest in community-based care, or educate media that the answer to violent patients leaving hospitals is not higher walls, its better care (or more clozapine [Sandoz Pharmaceuticals psychiatric drug for schizophreniaed].)
The mission statement outlining this campaign lists its Founding Sponsors": Abbott Laboratories, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Pfizer Inc., Sandoz Pharmaceuticals, SmithKline Beecham and Wyeth-Averst Laboratories.
How seriously are lawmakers and the public to take the disclaimer, In accordance with NAMI policy, acceptance of funds does not imply endorsement of any business practice or product"?
If challenged on their facts or arguments, members are exhorted to Stick to your guns. Repeat yourself if you have to do so. Repeat your ... points over and over.
The objectives are unequivocal: We can start to get our message across to the public, while at the same time using up media space and time that would otherwise go to anti-mentally ill sentiment.
That sentiment, presumably, incorporates the feelings of those who resist pouring yet more funds into an industry wrought with massive fraud and abuse, at the expense of taxpayers, employers and the swelling ranks of the nations uninsured.
Epidemic by Consensus
Anti-mentally ill sentiment could also be said to include those who cry foul at psychiatrists methodology for labeling and enumerating mental disorderswhich is by majority vote in hearings by committees of the American Psychiatric Association (APA). This ritual is pivotal to keeping the industry afloatregistered disorders providing the approved diagnoses with which to prescribe treatment and bill insurance plans.
Estimates of the prevalence of mental illness vary markedly, but in any case, the numbers (from the psychiatric industry) are constantly increasing.
The January 1994 edition of the Archives of General Psychiatry proclaimed that nearly 50 percent of the American population experience a mental disorder at some point in their livesa change from earlier estimates of 29 to 38 percent. The Archives explanation: The prevalence of psychiatric disorders is greater than previously thought to be the case.
The prevalence of disorders is in fact dictated by the psychiatrists official diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fourth edition (DSM IV). Disorders are voted into the manualor even voted out, such as homosexuality which had been in the manual but was later cancelled.
Psychologist Paula Caplan, who served as consultant to some committees approving disorders for the DSM, wrote of the voting process: I have been able to assess and monitor the truly astonishing extent to which scientific methods and evidence are disregarded as the handbook is being developed and revised.
Another psychologist who attended DSM hearings told a national news magazine that, The low level of intellectual effort was shocking. Diagnoses were developed by majority vote on the level we would use to choose a restaurant. You feel like Italian, I feel like Chinese, so lets go to a cafeteria. Then its typed into the computer.
Drawing No Line
Mental disorders contained in the DSM have been the target of grim humorsuch as disorder number 313.8 Oppositional Defiant Disorder, which is likely to be prevalent among teenagers who argue with their elders; 315.4 Developmental Arithmetic Disorder for young children experiencing difficulty with their math; Lottery Stress Disorder for lottery losers; and Chronic Tax Anxiety Syndrome to describe couples who experience extra worry and stress during taxtime in April.
Refusing treatment based on any one or more of the diagnoses could be deemed a symptom of mental illness 15.81: Noncompliance with Treatment Disorder.
The matter would be more humorous if it were not for the deaths, harm and loss of billions for constructive health care because of unnecessary and/or abusive treatment.
And where initial campaign rhetoric for mental-health insurance parity specified catastrophic or severe mental illness; ambiguity now reigns. Under full parity, all DSM diagnostic categories would be eligible for coverage. Yet even NAMIs own chief psychiatric researcher, E. Fulles Torrey, warns, When you start talking about mental disorders, then you are into really a black hole that includes coverage for...Woody Allens 33 years of continuous psychoanalysis.
Widening the Black Hole
Billions from government, taxpayers and employers have been sucked into that black hole since the early 1980s. (See A Health Insurance Disaster).
The broad campaign for mental health insurance parity was undertaken chiefly at national level, focused on selling the concept of parity. National lobbying efforts included moving the National Institute for Mental Health from the Alcohol, Drug Abuse and Mental Health Administration to the National Institutes of Healthwhose mainline business is research of organic diseasesand defining mental disorders as disabilities under the Americans with Disabilities Act.
Congress then also passed the Omnibus Reconciliation Act of 1990which permitted Medicare reimbursement for partial hospitalization servicesand the U.S. Food and Drug Administration approved a near panoply of new psychiatric drugs.
Meanwhile, the growth of managed care since the mid-1980s radically changed the field for everyday practitioners. Afield, who was a pioneer of managed care in the 1980s, laments how it turned out. Managed care is a bottom linerather than a health carenumber, he told Freedom. While managed care dictates treatment, doctors pump medication inappropriately, and hospitals warehouse patients.
Afield observes that the object in managed care to keep costs down (and profits up) has resulted in many patients being referred to social workers and mental health counselors who perform minimum therapy while physicians medicate.
Those in the field are not paid anymore to do therapy. They are paid to push medicine, says Afield. In order to make a living, one has to see patients for five minutes, maybe ten, charge 50 or 60 dollars, push a medication, and keep em coming. He has to deal in volume. The result, he says, is that patients are getting very bad treatment.
But driven by the bottom line, the industry proliferated.
So did fraud, followed by law enforcement crackdowns. And the response from the psychiatric industry has been a thinly disguised move to shore up losses and guarantee a profitable future.
BILLIONS from government, taxpayers, and employers have been sucked into the black hole of an escalating number of mental disorders.
Increasing the Pressure
Coincident with the first wave of civil lawsuits filed against National Medical Enterprises in 1991 (alleging insurance fraud, overtreatment and malpractice), NAMI called for a national policy to prevent discrimination against mental illness and co-sponsored a symposium on Capitol Hill to unveil a model insurance package that would include mental illness in the definition of catastrophic illness.
Despite these and other efforts, by 1996, the atmosphere was inclement. A national bill to mandate mental health insurance parity had been defeated and psychiatric institutions nationwide faced federal criminal charges.
It was then that psychiatric associations stepped up national lobbying for mandated parity, and concurrently, NAMI announced the new and invigorated Campaign to End Discrimination""a five-year nationwide effort to end discrimination against people with severe mental illnesses.
One result was the national Mental Health Parity Act (MHPA), pushed through Congress in September 1996 by Senator Pete Domenici (R-NM) as an obscure attachment to a Senate spending bill.
Domenici engineered the bills passage one week before scheduled hearings in which employer groups and insurance lobbyists would make their case against the Act. Yet despite the end run, those opposing the law were successful in negotiating concessions that weakened many of its provisions.
Thus, just weeks after the MHPA was passed, members of the American Psychiatric Association, attending a symposium at Congress marking Mental Illness Awareness Week, could be found arguing for more parity. And by 1998, the grass roots lobbying machine was back in operation, hawking the introduction of House Resolution 3568, the Mental Health and Substance Abuse Parity Amendments of 1998.
Although lobbyists continue to battle for stronger parity provisions at the national level, the disabled Mental Health Parity Act has had propaganda value at state level.
While most states had legislated some form of mandatory mental health benefits into existence over the past two decades, by 1996, only seven had enacted parity-type laws. But by 1998directly after passage and implementation of the MHPAbills for mandated mental health insurance parity cropped up nationwide. A majority of states saw through claims that it is necessary to mandate the insurance, and tabled or vetoed the bills.
If you want parity in mental health insurance, you can buy it, says Kentucky State Senator Dick Roeding. Kentucky has not passed parity legislation per se, but is battling the effects of laws passed earlier which achieved a similar effect. (See A Health Insurance Disaster).
One of the dangers of parity legislation was summed up by Carrie Gavora of the Heritage Foundation, who observed that legislators are increasingly taking action on issues determined by the political lobbying efforts of particular groups rather than by sensible medical priorities.
And opposition to mental health insurance parity continues to grow with the mounting evidence of the economic harm caused by mandated benefits, and each new revelation of psychiatric abuse and fraud.
Even if insurance companies did cover mental health, they would just be covering crap, remarks Afield. Its no longer a fieldits a business. Its amazing how the American public has put up with it.
Evidence shows that the American public is actually not so willing to put up with it. While the parity lobby insists that Americans need more access to psychiatrys wares, the public is saying something else.
A national poll provided to the House Ways and Means Committee as part of a 1995 Medicare study revealed that mental health services ranked last of those services for which patients were willing to pay a greater share.
With the continuing explosions of evidence of rampant fraud and abuse in the industry, it is certain that the countless individuals and families who have been betrayed by psychiatryamong them the tens of thousands who grieve the deaths of their children, relatives or friends from psychiatric treatment feel the same way.
Further, a poll published in Money magazine in October 1998 found that the majority of Americans are quite satisfied with their health care the way it is.
The American public can request and pay for mental health the same as for anything else. Otherwise, psychiatric associations and practitioners obtain an unfair advantage. True parity would dictate they exist on the same terms as other professionsand operate under the same standards and regulations.
Leveling the playing field would first mean repealing existing parity laws. Next would be to demand that psychiatric associations and lobbyists devote the same amount of time and money as they have to insurance parity to legislative efforts not to mention internal industry initiativesto stem psychiatric fraud and abuse. Minimal solutions involve stiffening criminal penalties, including automatic cancellation of licenses and reimbursement of fees and costs to payers; and an overhaul of regulations including holding psychiatrists fully accountable for their patients.
Only then could true parity be approached.