[Congressional Record Volume 141, Number 2 (Thursday, January 5, 1995)]
[Extensions of Remarks]
[Page E37]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                             MENTAL HEALTH

                                 ______


                          HON. LEE H. HAMILTON

                               of indiana

                    in the house of representatives

                       Wednesday, January 4, 1995
  Mr. HAMILTON. Mr. Speaker, I would like to insert my Washington 
Report for Wednesday, Nov. 2, 1994 into the Congressional Record.
                             Mental Health

       One challenge facing our country is improving mental health 
     care. Fewer than 40% of those who have ever suffered from a 
     mental disorder received treatment, despite significant 
     progress in developing successful remedies. The federal 
     government devotes resources to research and treatment.
       What is mental illness? Mental disorders have intertwined 
     biological, psychological and environmental roots. Many tend 
     to recur throughout a person's lifetime. Most mental illness 
     (other than alcohol or drug abuse) fall into one of three 
     categories:
       Mood disorders--While everyone has changes in mood, some 
     people experience periodic disturbances, the most common of 
     which is depression. Persons with major depression have a 
     persistent feeling of sadness, often accompanied by insomnia, 
     intense guilt feelings, or recurrent thoughts of death or 
     suicide.
       The other major mood disorder is manic-depressive illness, 
     in which people alternately experience periods of extreme 
     euphoria and major depression. The manic phase of the disease 
     may be marked by hyperactivity, irritability, decreased need 
     for sleep, and loss of self-control and judgment.
       Anxiety disorders--Fear and avoidance behavior are the 
     characteristic symptoms of these disorders. A person with 
     panic disorder has sudden, recurring attacks involving an 
     irrational sense of imminent danger accompanied by physical 
     symptoms such as heart palpitations and shortness of breath. 
     Obsessive-compulsive disorder involves repeated, intrusive, 
     unwanted thoughts that cause distress and anxiety, often 
     accompanied by a compulsive ritual, such as hand-washing or 
     cleaning.
       Schizophrenic disorders--Persons with schizophrenia do not 
     have multiple personalities. One of the most debilitating 
     mental illnesses known, schizophrenia is characterized by 
     distorted thinking, delusions, hallucinations, and withdrawal 
     from the outside world.
       Who suffers from mental illness? Recent studies found that 
     28 percent of adults will suffer a mental disorder in any one 
     year; five percent of them a severe disorder. Almost a third 
     of adults will have a mental illness during their lifetime. 
     While the overall rates of major mental disorders do not 
     differ for women and men, some are more common in one or the 
     other. Mental illness can strike at any age.
       How are mental illnesses treated? Treatment may include 
     medication, psychotherapy, hospitalization, or a combination 
     of these. Recent research has yielded discoveries of several 
     new drugs to treat mental illnesses. Today, most who suffer 
     from severe mental disorders can be treated successfully.
       What is the cost of mental illnesses to the nation? In 
     1991, the cost totaled just over $136 billion (not including 
     alcohol and drug abuse). The biggest cost associated with 
     mental illness is lost productivity. This is true in part 
     because mental illness often strikes people at the beginning 
     of their working years, in part because many people with 
     mental disorders do not get treatment.
       What is the federal government's role in mental health 
     care? The federal government plays a major role in research 
     into causes and treatments of mental disorders, primarily 
     through the National Institutes of Mental Health, Drug Abuse, 
     and Alcohol and Alcoholism. Congress has provided $1.3 
     billion for these efforts in 1995. In addition, the federal 
     government will provide $2.1 billion in 1995 for mental 
     health treatment and substance abuse prevention.
       Congress has also established specific programs for 
     providing mental health services to homeless individuals. An 
     estimated one-third of the homeless population in the U.S. 
     suffers from serious mental illnesses, and 30 to 60 percent 
     of the homeless mentally ill also are substance abusers.
       While it did not receive as much attention as other aspects 
     of the health care reform debate, discussion was given to 
     expanding mental health coverage. Most private health 
     insurance plans do not offer identical coverage for mental 
     illnesses and other ailments, nor does Medicare. For example, 
     almost 80% of large- and medium-sized businesses which 
     provide health insurance had more restrictive hospital 
     coverage. Many plans put lower limits on lifetime expenses 
     and outpatient coverage.
       Critics of expanding coverage for mental disorders argue 
     that they lack clear diagnostic criteria, potentially leading 
     to coverage for almost any problem. They believe that too 
     much money would be spent treating the so-called ``worried 
     well,'' who are not in serious need of help. They also assert 
     that mental illnesses often cannot be treated effectively.
       Advocates for expanded coverage assert that mental 
     illnesses are as definable, diagnosable, and treatable as 
     other disorders. They also contend that the lack of private 
     insurance coverage puts an unfair burden on the public, which 
     currently pays for over half of all mental health treatment. 
     Finally, they argue that the cost of not providing adequate 
     mental health care coverage is ultimately higher than 
     providing it.
       It is hard to determine what shape the health care debate 
     will take next year, but the issue of mental health coverage 
     will not go away. I believe we must work toward a health care 
     system that provides adequate mental health and substance 
     abuse services. This will not come easily or cheaply. Both 
     private and public health care plans should phase in 
     coverage, allowing time to develop the capacity to deliver 
     and manage a more comprehensive mental health and substance 
     abuse benefit. Eventually these plans must include treatment 
     in a variety of environments, ranging from inpatient hospital 
     to community and residential treatment. States must be given 
     wide flexibility to promote and encourage these plans. I do 
     not underestimate the difficulty of this task, but neither do 
     I find acceptable the view that because of the problems we 
     should exclude coverage for the mentally ill.
       In addition, the federal government should continue to 
     support research and treatment that can return mentally ill 
     individuals to healthy, productive lives.
     

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