No diagnosis needed

Elsewhere in this week’s edition of the RN&R, we have our annual Health Guide supplement. In previous years, we’ve focused on women’s health and end-of-life issues, among other areas. This year, the focus is on mental health.

Corruption is endemic to the health care industry, which profits from other people’s suffering. And reform is needed throughout the health care and the health care insurance industries.

But there is a special set of problems for mental health care insurers—which are in desperate need of reform. The 2008 federal Mental Health Parity and Addiction Equity Act requires parity for mental health alongside physical health in health plans, and was strengthened in 2010 with the passage of the Affordable Care Act. Despite these laws, mental health care is not treated with the same priority as physical health by insurance companies.

In May, a federal judge ruled against UnitedHealth Group’s approach to mental health care coverage. The judge ruled that the insurer’s policies were discriminatory and profit-driven to the point of damaging coverage. Part of the problem is that, United, like many health care insurers will only cover costs for treatments considered medically necessary. This requires clinicians to submit a diagnosis for a client in order to bill the insurance company, which creates several problems.

Number one, it increases the stigmatization of mental health care. You must have a diagnosable mental health problem in order to see a therapist—therefore only “crazy” people see therapists.

Secondly, because therapists, like other medical professionals, are increasingly specialized, it means that a patient seeking mental health assistance must self-diagnose before even trying out a potential therapist. And there’s no mental health problem that can’t be made worse with a few hours of scrolling through WebMD.

And mental-health problems are especially acute here in Nevada, a state with very little public funding for health care of any kind—and with easy access to things, like gambling, alcohol and prostitution, that can exacerbate mental health problems. This is a state whose most famous solution to addressing mental health problems, as first reported by the Sacramento Bee back in 2013, was to put patients on buses and send them to other states with (hopefully) better facilities.

One of our sources for the health guide suggested a solution to the problem: “Get rid of the syndrome-based reimbursement system.” Patients should have the opportunity to see a therapist at least a few times a year, pay a modest copay, and get a little help, clarity and guidance without first receiving a diagnosis.

This might lead to better management of some of their personal issues, so they don’t ever become fully diagnosable problems. Think of it as the mental health care equivalent of preventative care.