FEW THINGS COULD be more stressful than being diagnosed with a chronic physical illness. But for most Americans, at least there is the comforting thought that the financial impact of such a diagnosis will be covered for by a health plan.

A person who suffers from a mental illness, however, might not have that same reassurance. While advocates maintain that mental health disorders can be just as chronic and debilitating as physical conditions, many plans don't include benefits for patients seeking treatment. As a result, people suffering from a mental illness often are forced to go without treatment.

"Cancer is a perfect example," says Diana Ramsay, executive vice president and COO of Sheppard Pratt, a Baltimore-based psychiatric hospital and provider of psychiatric services. "If cancer weren't covered by a health plan, most patients wouldn't be able to afford the treatment. It's the same way with mental health patients."

Mental health benefits have failed to achieve parity with physical health benefits because of the stigma attached to mental illness, according to Ramsay and other advocates. However, the numbers show that ignoring the problem doesn't make it disappear. Estimates show that mental disorders annually cost employers about $300 billion in absenteeism and lowered productivity alone.

AN OVERWHELMING FEAR How strong is the stigma? Government research shows that many people would rather tell employers they have committed a petty crime and spent time in jail than admit to being in a psychiatric hospital.

As with any physical illness, a person diagnosed with a mental disorder can be treated. By seeking psychiatric help or using drug therapies, these people can live normal, productive lives.

But because of the fear of being stigmatized, many people who suffer from a mental illness or disorder never seek that help.The US. Surgeon General's Report on Mental Health in 1999 identified the stigma as a central obstacle to people receiving quality mental healthcare.

"We know from many things, including the Surgeon General's report, that among the obstacles that people with mental health disorders face are the issues of stigma and cost," says Russ Newman, executive director of the American Psychological Assn. (APA). "If we can provide coverage that isn't differentiated from physical health coverage, then we will move closer to destigmatizing the whole area of mental health."

The stigma remains because mental illness is still viewed as a problem of personal responsibility or behavior, says Jeffrey Buck, associate director for organization and financing for the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health.

"Therefore, it is not in the same category as other types of illnesses," Buck points out. "Plus, there is a general conservatism about being more generous in any area, not just mental health, compared with other plans."

A PREVALENT ISSUE The question of just how many people experience some form of mental illness is difficult to ascertain because the definition and diagnosis of mental illnesses have changed over the years. The Department of Health and Human Services estimates that 20% of the U.S. population-about 44 million people-is affected by a diagnosable mental disorder during a given year.

"The prevalence is widespread, and there are people who certainly fall through the cracks ... people we never hear about," says Ralph Ibson, vice president of government affairs for the National Mental Health Assn. (NMHA), a nonprofit organization addressing all aspects of mental health and mental illness. "What is significant is that a large percentage of people don't get treatment."

Employees who suffer from a mental illness or disorder are a big concern for employers because of the potentially negative impact on productivity. The cost associated with absenteeism and lost productivity because of anxiety disorders is $42 billion annually. In 1996 (the most recent year for which estimates are available), the United States spent more than $99 billion for the direct treatment of mental disorders, substance abuse, Alzheimer's disease and other dementias.Overall, absenteeism and lost productivity because of all mental health disorders cost more than $300 billion annually.

During the past decade, there has been some movement to bring mental health coverage into parity with physical health coverage:

Congress passed partial parity legislation in 1996 aimed at reducing the gap between mental health and other types of health coverage. But the legislation contained a sunset provision and expired in 2001.

President Bush voiced his support for mental health parity legislation this year.

Thirty-seven states have passed laws banning discrimination of insurance and managed care coverage of mental illness.

In 1999, President Clinton signed an Executive Order instituting a policy of mental health and substance abuse parity in the federal employee health benefit plan, which covers about nine million workers.

"There was a lot of fear when the initial legislation was passed that it would add a considerable amount of bottom-line cost increases for mental health coverage," says Gregg O. Lehman, president and CEO of the National Business Coalition on Health (NBCH), which represents nearly 8,000 self-insured employers.

However, the opposite has been true. A study conducted by PricewaterhouseCoopers and released last year by APA echoes that statement. The study indicated mental health coverage on par with physical health coverage would increase employers' costs by 1%, or $1.32 per enrollee per month.

Parity advocates insist that if people suffering from mental illnesses have access to healthcare benefits, they would be more apt to seek treatment. "It would

MORE EVIDENCE Full parity, however, is troubling to employers, Lehman says. Employers believe they need to see more analysis as to whether it is cost-effective for them to provide benefits for a range of mental disorders and illnesses.

"Employers are concerned that behavioral health programs will not be based on evidence-based medicine, thus causing variations in outcomes leading cause of higher costs," Lehman notes.

NBCH has worked with SAMHSA for the past two years to develop a depression management module to standardize ways to measure health plan quality on certain issues. NBCH will ask health plans how they identify members with mental or behavioral health problems and what type of interventions they have for people diagnosed with such disorders.

Ramsay, who has worked with patients with mental disorders for about 20 years, says it's logical to assume that if full parity existed, more people would have access to treatment and services, and thus seek help. If people get the help they need, she adds, they would be able to lead healthy lives and become productive members of society.

Ramsay and other parity advocates believe that equal access to healthcare would chip away at that stigma. "It stands as a beacon underscoring that mental illness and physical illness are not separate issues," Ibson says.

APA's Newman says money is not the issue. "The issue is about treating people with mental health disorders differently than this country has treated people with physical health disorders," he says.

This Article has been submitted by the Jeremy's Prophecy Dot Com team for informational and educational purposes. Jeremy's Prophecy Dot Com is a website dedicated to telling the story of Jeremy Jacobs, a character in the novel, Jeremy's Prophecy Dot Com.