Out Of The Shadows - mental health coverage

Kiplinger's Personal Finance Magazine, Jan, 2001 by Jane Bennett Clark

HEALTH | Managing DEPRESSION is becoming easier -- if you can afford the cost.

FROM THE WINDOW of her bedroom, Kate Lynnes has watched a world she couldn't be part of. Half a continent away, Willy Herbert knows what it's like to view life from the shadows, unable even to rise from bed and face the day. Lynnes and Herbert have never met, but in some ways their lives are strikingly similar. Both are lawyers who have thrived in their own firms. Both have gregarious personalities and activist bents they hope to parlay into politics. And both have experienced dark moods so crushing that one has entertained passing thoughts of suicide and the other has tried it--repeatedly.

Lynnes and Herbert suffer from depression, a disorder that affects more than 19 million adults in the U.S., and racks up more than $43 billion annually in medical costs, lost productivity and absenteeism. Although the vast majority of people with depression remain in the work force, the disease can complicate other medical conditions and contribute to permanent disability.

Yet advances in research on the brain and behavior have rendered depression and other mental illnesses far more treatable than in the past. "The ability for people to recover and have very high-functioning lives has just multiplied," says Mary Graham, senior policy adviser for the National Mental Health Association.

People with major depression--the symptoms of which include sleep and eating disturbances and persistent sadness--usually respond well to talk therapy, along with medications that address chemical imbalances in the brain. Bipolar disorder, characterized by cycles of mania and despair, is considered to be more complicated to treat. But it, too, can usually be managed with therapy and medication.

And drug therapy has become more effective in recent years with the introduction of a class of medications thought to improve mood by boosting the level of seratonin in the brain. Not only do these drugs produce good results, says Graham, but "people's compliance with medication therapy has gone up because they don't have the side effects they used to have."

Despite such advances, most adults with depression still avoid getting help. One hindrance to care is the out-of-pocket expense, which can be significant for long-term or intensive therapy. "There is a vast disparity between what your insurance will cover for mental-illness care and what it will cover for medical care," says Dr. Nada Stotland, a psychiatrist in Chicago. Insurance plans, which often farm out mental-health management to specialty companies, favor limited outpatient sessions with cost-sharing of up to 50%, and set tight restrictions on inpatient care. Those limits discourage many people from getting appropriate treatment, says a recent Surgeon General's report on mental health, and may leave others "to bear catastrophic costs themselves."

For Herbert, the price of mental-health care has had only a moderate financial impact. After overcoming an episode of major depression, he now manages his chronic mild depression for less than $1,000 a year, an amount he deems reasonable, considering the alternative. "You're talking about a matter of life and death," he says. "You can't put a price on it."

For Lynnes, insurers did put a price on it: Huge hospital bills and inadequate coverage plunged her into debt and drove her to the brink of bankruptcy. Today, her health and her career largely depend on what insurance coverage is available to her, if any.

"The weight of the world"

WILLIAM "Willy" Herbert, 44, is no stranger to crisis. A self-described "redneck, pit-bull attorney" who practices in Ashland, Va., Herbert deals in the daily hassles and hard knocks of other people's lives. "Basically, it feels more like running an emergency room," he says of his one-man practice. "People don't come to an attorney to exchange pleasantries. They've got a problem."

In the spring of 1998, Herbert's own problems were piling up. A family member was struggling with depression. The law practice in which Herbert had worked for eight years was disbanding, not without bruised feelings. The Herberts' daughter, Sarah, was about to graduate from high school. "I had to set up a new office and figure out how to finance college," says Herbert, who was putting in 70-hour workweeks. He suddenly found himself overwhelmed.

"Ten years before, he would have been able to say, `I can do this,'" says his wife, Alane, a soft-spoken school-teacher with a wide smile. Now, "he had the weight of the world on his shoulders."

To talk through his feelings, Herbert visited a psychologist and a psychiatrist, using Alane's HMO coverage through her employer. The psychiatrist prescribed Prozac, which is considered highly effective in treating major depression. Like other antidepressants, Prozac takes three to five weeks or longer to kick in. Meanwhile, Willy's anxieties were mounting. Says Alane: "The thing that really scared me was that he really did not see any positive way out of it. He woke up one morning and knew he couldn't go to work."