Mental health care is mired in a ghetto

Have you ever worried that you were “crazy,” felt seriously depressed, anxious or thought of suicide? How about your family tree – a few “nuts” in there?

If the answer is yes, that just makes you normal. If the answer is no, that probably makes you a bit delusional, in which case the answer is really yes. Read on regardless, because today’s column is about our system of mental health care, which means it is about you and yours.

Mental health care is the ghetto of the American health care system, a ghetto in which Americans with serious mental illness are confined primarily by our national and personal ignorance about mental illness. It is a poverty-stricken ghetto; payment for mental health care is limited in ways a cancer patient would find unimaginable.

America’s prisons are, in many ways, the backbone of its mental health system; on any given day there are about 280,000 patients with severe mental illness in our prisons, where there is little mental health care, and about 70,000 patients in our public psychiatric hospitals. Police and prison guards are among the mental health care system’s principal workers; handcuffs and cells are among its principle treatments. If the American health care system was a bus the mentally ill would have to ride in the back and give up a seat when someone with “real” disease needed it.

Current law, health insurance policy and health care economics are based on our national ignorance about mental illness, and benefit from it; treating mental illness as though it is not a real disease allows it to be paid for as though it is not real disease, meaning poorly. Medicaid, for example, does not pay psychiatric hospitals for care of Medicaid patients. Medicare and other health insurers limit payment for treatment of the mentally ill more than most other patient types. Many insurance companies do not recognize suicidal patients as being emergently ill, even though being suicidal is a heart attack of the psyche and can be as deadly as a gunshot

to the chest.

Our bias and ignorance extend into our language and culture. “Nuts” and “crazy” are not simply descriptive terms; they are derogatory. Arthritis gets you sympathy, but schizophrenia gets you ostracized. In many states those with serious mental illness cannot vote, despite the fact that the purportedly sane among us can vote based on what Don Imus says on the radio.

Sony Corp. produces the “Twisted Metal: Black” video game in which the ‘bad guys’ are dangerous characters released from a mental institution. In the Sony Pic-tures/Brookline Productions animated TV series “Max Steel” the enemy is a character named Psycho, and Mattel Toys has made a Psycho action figure. We would never tolerate a cartoon series or toy line in which the villain was evil because he had diabetes, heart disease, and one leg.

The ghetto survives despite better medications for treatment than ever before, and the fact that treating mental illness is very cost effective. The inadequate treatment of mental illness pushes much larger costs onto society, where those costs are hidden and avoided by the health care system.

There is much to be done about all of this that is easily done by all of us. First and foremost we must tear down the mental health care ghetto built from the bricks and mortar of our bias and ignorance. Our understanding of mental illness needs to be dragged out of the Victorian era where women could not vote and their undergarments contained whalebone. Mental illness is a disease as real as lung cancer, and as biochemical as diabetes. Depression and schizophrenia, for example, are the result of profound disturbances of brain chemistry and function.

Mental illness is a killer; suicide in America takes as many lives every year as five Sept. 11 World Trade Center attacks, yet no American president has ever stood before the U.S. Congress and declared a war on mental illness. Its victims usually die quietly and alone, in rooms and alleys darkened by their depression and our collective neglect.

We must tell our representatives in Washington to support mental health care parity legislation now before the Congress. We should support organizations such as the National Alliance for the Mentally Ill (www.nami.org), and learn more about mental illness during Mental Illness Awareness Week, Oct. 7-13. We should remember that suicide is the third leading cause of death among American teens, then shut off TV’s “Max Steel” until it cleans up its act, consign Psycho action figures and Sony’s “Twisted Metal: Black” video game to the trash, and shame those companies into responsibility.

These are the candles we can all light and hold against the darkness of our ignorance, and against the day when any of us could find ourselves or a family member caught in the suffocating gloom of mental illness. That is where we would all go but for the grace of God and normal biochemistry.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.