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HMOS MAKE A BIG MISTAKE WHEN THEY GIVE SHORT SHRIFT TO GOOD MENTAL-HEALTH CARE

The ancient Greeks promoted the concept of a sound mind in a sound body. Now, centuries later, we are beginning to understand anew that a person's emotional well-being is essential for physical health. Recent research reported in The News indicates that depression is closely associated with coronary heart disease, and moreover, that depression is more highly predictive of coronary problems than are the traditional culprits of smoking and couch-potatoism.

For some reason, we, as a society, have neglected the common-sense understandings of the ancient Greeks. The fact that mental and physical health are inextricably intertwined has escaped us, and we have concentrated most of our health-care efforts on dealing with physical maladies. Many of these are the partial result of psychological problems.

Technological advances for dealing with physiological conditions, drugs that make living with stress tolerable, and misunderstanding of psychological disorders have all helped allow us to ignore the importance of emotional well-being. We need to reconsider our mechanistic approach to health care, which reduces human beings to organ systems. It is time to recognize the importance of mental health to our overall quality of life.

Far from being rare, psychological problems are commonplace. One out of five Americans suffers from a diagnosable mental disorder. Up to 70 percent of visits to primary-care physicians have been estimated to stem from psychological factors.

One survey found that 48 percent of people in the United States between the ages of 18 and 54 will seek treatment for emotional concerns during their lifetime.

It is unfortunate that the insurance industry has chosen to ignore the relationship between psychological and physical health. Although legislation was recently passed giving mental health care parity with more traditional forms of medicine, in practice psychological care gets short shrift. It is also unfortunate that people often enroll in health-care plans without considering the importance of quality, accessible mental-health services.

Managed-care health plans and HMOs frequently lure consumers with low co-payments for physician visits or with free prescriptions but provide inadequate psychological services. HMOs spend, on average, only 2 to 3 percent of their budgets on mental-health services.

Worse, managed care's marketing of psychological health benefits is often deceptive. For example, plans often promise 20 to 30 outpatient psychotherapy visits per year but realistically pay for far fewer sessions, with the managed care company citing "medical necessity" to limit treatment. This may be why only 10 percent of respondents rate the psychological services of their HMOs as "excellent."

The success of mental-health treatment depends upon the therapeutic relationship between client and therapist. This develops only when a client can talk to a therapist in absolute confidence. Many managed-care plans require the client to discuss personal problems with an anonymous voice on the telephone before they will grant a single treatment session. This alone may dissuade a person from seeking help for a psychological problem. Managed-care plans also require the release of personal information to "utilization-review" bureaucrats, undermining confidentiality in treatment.

If care is approved, the client is typically given a short list of "panel providers" from whom to select a therapist.

It is hard to understand the ostrich-like behavior of the insurance industry, for those corporations acknowledging the importance of psychological health by funding mental-health benefits have reaped large rewards. After removing all restrictions on treatment for emotional problems, for example, Digital Equipment Corporation reduced its total health-care costs by approximately 100 million dollars over four years. Kaiser Permanente realized a 50 percent decrease in the number of physicians seen by patients who were receiving psychological services. The Kennecott Copper Corp. saved nearly six dollars in medical-care costs for every dollar spent on mental health.

Cost comparison studies show a decrease in total health-care costs following mental health interventions even when the cost of intervention is included.

The Psychological Association of Western New York, the professional organization for over 300 psychologists on the Niagara Frontier, urges consumers to look carefully at their insurance coverage for mental-health services. Employers' benefit managers should be concerned, too. Remember: Quality psychological care may literally save a life.

CHARLES A. CHRYSTAL, Ph.D., is president of the Psychological Association of Western New York and has a private practice in Buffalo.

For writer guidelines for columns appearing in this space, send a self-addressed, stamped envelope to Opinion Pages Guidelines, The Buffalo News, P.O. Box 100, Buffalo, N.Y. 14240.

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