[Congressional Record Volume 142, Number 136 (Friday, September 27, 1996)]
[Senate]
[Pages S11568-S11569]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              MENTAL HEALTH CARE: AN AGENDA FOR THE FUTURE

 Mr. FRIST. Mr. President, yesterday, the ``Mental Health 
Parity Act of l996'' was signed into law by President Clinton. Mr. 
President, the act provides parity of coverage for treatment of mental 
illness. The debate over the bill was both stimulating and educational, 
in that it encouraged many of us to learn more about issues affecting 
the management of mental health disorders. I believe that, as a group, 
we now have a greater awareness and sensitivity to this area. I would 
like to take this opportunity to present some of the issues which I 
feel must be addressed.
  Mental health may be affected by numerous factors ranging from 
outside stressors, presenting in ways that may be difficult to manage, 
to physical disease or genetic defects that impair brain function. The 
erosion of our traditional social support systems, including 
fragmentation of extended and nuclear family structures, have 
contributed to the morbidity of mental disorders. Increased complexity 
and stress in society are also responsible for the higher incidence of 
symptoms.
  Consequently, alcohol, drug abuse, and mental health disorders affect 
18-30 percent of adults annually. Suicide claims 30,000 lives each 
year. We are also faced with skyrocketing costs and utilization of 
mental health and substance abuse services which now represent 4 
percent of the GDP. However, these costs represent only one-fourth of 
the total price. Employees with behavioral health problems experience 
higher accident rates, use more health benefits, and have lower overall 
work performance ratings than other workers. The costs of crimes which 
are committed as a result of behavioral disorders must also be 
included.
  As a physician and surgeon, I understand the impact of mental illness 
on the lives of my patients and their families. I also understand the 
importance of good psychiatric care. Advances in medication and 
psychological therapeutic techniques have improved our ability to treat 
these disorders effectively. In addition, the destigmatization of 
mental illness and chemical dependency have led to a greater 
willingness on the part of the general public to seek help for these 
problems.
  However, traditional techniques have not been effective in 
controlling either the costs or quality of care provided in this arena. 
Reorganization of public sector, local authority, and managed care 
contracting has begun and a niche industry of specialized managed 
mental health/substance abuse organizations or carve-outs has 
developed.
  Unfortunately, we cannot necessarily rely on competition and the 
market to solve these problems. These forces may fail because of 
externalities and information problems. Even our health care providers 
have not always received the education about mental illness necessary 
to perform their tasks. At this point, no one is sure that the new 
programs are any more effective than the old ones.
  As a transplant surgeon, I understand the value of teamwork. I 
believe that we must use that approach if we are to solve these 
problems. Government, payers, providers, and consumers must each 
contribute solutions. Together, we can accomplish the following 
objectives:
  First, parity of coverage between mental and physical disorders must 
be encouraged.
  Second, payers must develop incentives for providers to provide 
appropriate care as well as information for patients.
  Third, we must educate providers about the most cost-effective ways 
to deliver high quality care. Medical school curricula should be 
revised to provide more in-depth training on mental health and 
substance abuse disorders. Reimbursement mechanisms for graduate 
medical education must be changed so that residents are less tied to 
acute-in-patient facilities. When they are placed in facilities across 
the continuum of care they will receive more exposure to issues of 
chronic behavioral disease management.
  Fourth, we must learn how to measure the real value of care we 
provide in

[[Page S11569]]

terms of health improvements per dollar spent on care. We must also 
consider the social consequences of that care.
  Fifth, we must learn how to better estimate the effects of cost 
containment measures on treatment cost effectiveness.
  Sixth, we must encourage the development of consistent standards for 
use of evidence in policy debates.
  Mr. President, this Congress has worked in a bipartisan fashion to 
address mental health parity. As policy makers, we can continue to 
address the needs of the mental health community by working with 
educators, health plans, employers, and researchers to encourage them 
to meet these other important objectives. I believe our health care 
system can meet these goals. However, it requires cooperation from the 
entire health care community. I urge my colleagues in the U.S. Senate 
to consider the issues of mental health in this broader context; as 
well as, to continue to educate ourselves on the mental health issues 
that impact our health system and society as a whole.

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