Financially Surviving a Depressive Episode
Experiencing a depressive episode in our society is not cheap. Hospital rooms run $800 a day, psychiatrists charge from $150 to $180 an hour, and antidepressants may cost as much as $2.80 a pill. During my depressive episode, I was fortunate to be covered by the group insurance plan from my previous job, which paid for a majority of my hospitalization and outpatient costs. Most individuals are not so lucky. As a rule, insurance plans are structured so that the money allotted for mental health treatment is far less than the funds given for physical health benefits. This means that many people who suffer from depression run out of insurance before they run out of illness.
This lack of parity is most discriminatory for the self-employed. For example, as a self-employed writer, I purchase my insurance from the Providence Health Plan, one of the premier managed care companies in the Pacific Northwest. If I were in a car accident, had a heart attack, or developed an acute infection, my insurance would pay for 80 percent of my hospitalization costs. But if I suffered a relapse into depression and needed to be hospitalized, the Providence Health Plan would pay absolutely nothing for my treatment! Moreover, I cannot sign up for better mental health coverage. As incredible as it seems, mental health inpatient benefits for the self-employed are unavailable in the state of Oregon.
Day treatment coverage is not much of an improvement. Under current law, the state of Oregon mandates a maximum of $1,000 worth of benefits (which pays for only one week of outpatient care) every 24 months. When I attended the day treatment program at the Pacific Counseling Center, it took nine months before I got well. Fortunately, I was covered by my employer's group health plan. But what if I were to have a relapse now? Where would I go? What of other self-employed people who are currently in the hell of depression? How many them are literally dying because they cannot get the care they deserve?1
These discriminatory policies reflect a long-held societal stigma against mental illness. This stigma is reflected in the fact that for every $100 of cost created by mental disorders, 30 cents is spent on research (compare that to $1.63 for cancer research). We will know that attitudes have changed when we see “depression awareness” booths (just like today's blood-pressure stations) set up in airports and other public facilities, in which individuals can receive free screenings to determine if they suffer from clinical depression or a related mood disorder.
Fortunately, a shift in attitudes is slowly taking place. In the first White House Conference on Mental Health (June 7, 1999), President Clinton stated, “As a nation founded on the principles of equality, it is high time that our health plans treat all Americans equally.” He then announced that the federal government, the largest self-insured institution in the country, would amend its insurance coverage so that mental health services are on a par with physical health treatments. Under the new policy, private health plans covering federal employees and their families could not set limits on the number of outpatient visits or days spent in a hospital for treatment of “recognized mental health disorders” such as schizophrenia, bipolar or manic-depressive disorder, and major or clinical depression. Moreover, the policy would bar making co-payments higher for mental health disorders than those for the treatment of physical illnesses. The administration hopes that this policy will be a model for the rest of the health care industry.2
In this vein, I plan to join with the National Alliance for the Mentally Ill (NAMI) in lobbying the Oregon legislature to pass a law mandating that insurance companies in this state provide equal coverage for mental illness. If you have similar concerns about your state's insurance coverage for mental health, I encourage you to get involved. It is time to put benefits for mental and physical health on an equal playing field, thereby guaranteeing that those who suffer from the terrible malady of mental illness can receive the same compassionate care that is offered to other patients with “physical” problems.
Replacing Lost Income
A second economic challenge that many people suffering from depression face is replacing lost income, especially when the illness is so disabling that one can no longer work. For those individuals who do not have insurance and/or independent resources, financial support is available, thanks to Social Security benefits provided by the federal government.
A person who can document that he or she is suffering from a disabling mental illness is eligible for SSD (social security disability income), and, if his or her income is low enough, for SSI (supplemental security income). After benefits have begun, he or she can then receive Medicare, which pays for inpatient psychiatric care and some outpatient services.
Although the monthly income from SSD and SSI is extremely modest, recipients do seem to get by. During my stay at day treatment, I saw many people get well because they were supported by disability income and their therapy was paid by Medicare. To learn more about obtaining assistance, you can call the Social Security Administration at (800) 772-1013. In addition, a number of attorneys and social workers specialize in helping people with disabilities to apply for Social Security benefits. Ask for a referral from a local mental health center or consult the Yellow Pages. Locate the section advertising attorneys, and then look for lawyers who are listed under the subheading, “Social Security.”
1 While there have been reports in the media on people dying from physical illnesses that were neglected by the managed care system, no one has reported on suicides due to untreated mental illness. I can assure you that it happens, since untreated depression is the leading cause of suicide.
2 To learn more about the government's support of mental health reform, visit the White House Web site on mental health (http://www.mentalhealth.gov).