Eliminating mandatory psychiatric coverage: toughening up America and saving millions of people billions of dollars
In a front-page article last week, The Washington Post said that the Trump Administration perceives the explosive prescribing of psychiatric drugs to children as a threat to the well-being of children, and mirrors the similar increase of adults’ being so prescribed.
Those concerns miss the forest for the trees. The major threat is that under the Biden Administration and before, the over-diagnosing of mental illness and prescribing of talk and drug therapy for adults and children has skyrocketed, with adolescent prescriptions for anti-depressants rising 43%.
On Fox’s The Five on Tuesday (February 11), the good pundits therein discussed the alleged mental illness epidemic that has enveloped the country, exemplified by reports from Fortune Well (controlled by Fortune Magazine) online which reported that “Therapists who spoke with Fortune this week expressed that post-Election Day felt different than usual because they, in most cases, were dealing with the same grief and fears and disappointment as their clients.”
What was the cause of their psychological stress?
The election of Donald Trump.
Richard Fowler, one of the guest liberals on Fox, recommended on the show – without dissent from the four conservatives on the panel — weekly therapy for ”everyone.” He never mentioned who pays for it. It is an unquestioned good to progressives and perhaps now to conservatives too.
One wonders if Fowler, an avowed gay man, and other supporters know how anti-gay institutional psychiatry has been, diagnosing homosexuality for decades as a mental disorder, later changed exclusively to ego-dystonic homosexuality, a disorder if and only if a gay person did not wish to be gay. Subsequently, all categories of sexual predilection were removed from The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association.
Before the death of psychiatrist Dr. Thomas Szasz over a decade ago and before the passing of “parity” in mental health coverage, there was a growing suspicion, especially among conservatives in the overriding fallacy of the medicalization of people’s problems, which Dr. Szasz called in his seminal work, The Myth of Mental Illness.
Now that the debate over the existence of “mental illness” has largely disappeared, conservatives, like their liberal political opponents, use the psychological problems and excesses of people with whom they disagree as strategic discrediting rhetoric and otherwise normalize its reality.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that requires parity in coverage of mental health and substance use disorders.
In 2010 the Mental Health Parity and Addiction Equity Act was paired with Obamacare regulations to allow all mental health care to be mostly paid for by insurance to anyone diagnosed with a psychiatric or psychological disorder. Thus, the misnamed Affordable Care Act (ACA).
Many of the friends and followers of Dr. Szasz had maintained for decades that the rhetoric of mental health in America, promoted by psychiatric and psychological interests, creates a quiescent public ready and willing to have their problems in living defined as psychiatric disorders, treatable by drugs and talk by medical doctors of psychiatry and doctorates in psychology, although the problems they are “treating” are not medical phenomena and are not diagnosed medically, that is, by any X-Rays or blood tests or any physical examination whatsoever.
Further, the taking of illicit drugs is a choice that should be disincentivized, not an illness that must be “treated.”
If Elon Musk and President Donald Trump are serious and fearless – and one thinks that they manifestly are — about the dual goals of saving the American people money and increasing their independence and control of their lives, they should start by terminating the mandatory health insurance that Americans pay for mental health.
According to a CNN Survey, 90% say mental illness is a crisis in the United States.
According to surveys conducted by the National Institute of Mental Health, about 23.1% of all U.S. adults suffer from mental illness with about ½ receiving treatment. Other surveys come up with much larger estimates. You cannot disprove any estimate. Not surprisingly, the greatest costs occur in liberal states such as New York and California.
Most people think that “mental illness” is validated medically. It is not. There is no validation whatsoever.
According to U.S. News, “Mental illness costs the U.S. economy $282 billion every year, equivalent to the average economic recession, researchers report.”
This actually seems like an underestimation of all of the costs of drugs, therapy, lost time off work, and all the suffering of people who are convinced that they have a disease.
Let’s look at a typical diagnosis, although it is hard to define typicality in psychiatric diagnosing.
“Adjustment Disorder” is a default diagnosis for “the worried well” in the medical sophistry of mental health professionals.
It is the “garbage” diagnosis used when a person is unhappy about something and there is not another immediately usable term for a diagnosis, a psychologist once confided to me.
Mr. President and Mr. Musk: to eliminate the terrible financial and psychological costs of mental “treatment,” rid us of mandatory mental health care coverage in the Affordable Care Act.
Richard E. Vatz https://wp.towson.edu/vatz/ is a Distinguished Professor Emeritus of political rhetoric at Towson University and author of The Only Authentic of Persuasion: the Agenda-Spin Model (Bookwrights House, 2024) and over 200 other works, essays, lectures, and op-eds. He is the benefactor of the Richard E. Vatz Best Debater Award at Towson. The Van Bokkelen Auditorium at Towson University has been named after him.
Earl, first, I must say as a person who has taught political and psychiatric persuasion for over a half-century, your first response led me to infer that you were an unserious responder, but your second response made me infer that indeed I was interacting with a thoughtful professional.
I shall miss some of your points, but here are my reactions.
1. Throughout my article, I argued what I believe is the bottom line: that psychiatric and psychological help is not medical and should not be funded by mandatory insurance, even though drugs are sometimes administered (way, way too often, I think we agree). Still, I should have in my original article made the caveat that I have made in numerous publications; namely, that children can sometimes need professional help when parents know of no other source for help.
2. The problems of a professional using procrustean categorization is, as you describe, understandable, but it is utterly inaccurate…these are not “illnesses” or “disorders” and so labelling children or older people with such self-fulfilling prophesies of problems creates terrible miseries in life. I have seen people who use their diagnostic labels in discussions throughout their lives.
3. There are so many caveats in your interesting responses that I don’t know wherein we disagree starkly, but keep in mind that I am not arguing for the end of mental health activities, just the mandatory insurance therein. Incidentally, there was no decrease in the suicide rate from 2008 on through 2018 or so, and what there has been has been has not correlated with the making of psychological coverage mandatory.
4. Some of your personal experiences reinforce your thoughtfulness and the complexity of people’s experiences, but it also points to the fact that there are some financial motives behind the psychologizing of our society.
I am convinced by your note that you are a decent and ethical man and professional, but we do have significant disagreements. If I had a child relative whose behavior was intractably unchangeable, I might recommend that he or she see you.
Richard
Well, Earl, I have written extensively on these matters for about 1/2 century and was a colleague of psychiatrist Szasz…Google Vatz on psychiatry and mental health, and google “vatz” on psychiatry and mental health…
When the issue is whether psychology and psychiatry are authentic medical matters, “expertise” is a debatable concept.
Try thinking about the issues at hand rather than just reacting angrily without substance…
Vatz
Fair enough, so here is why I was disappointed with what you wrote.
1. I agree with Szasz and read his book about the medical model when in graduate school. I still have it. Yes, the medical model does not work in mental health. But what you don’t address is that clinicians are pushed by the insurance industry to make a diagnosis in the FIRST session. That session can be only 45 minutes to an hour. If we don’t do it, then they won’t pay. So, what we try to do is either give a preliminary diagnosis based on the symptoms someone is experiencing or a more common diagnosis. Many people either have anxiety (Generalized Anxiety Disorder) or they are struggling to adjust to an event or situation, so we may give them Adjustment Disorder. Sometimes another disorder, if identified, could cost the person their job or even reputation. We have to be careful while trying to be as ethical as possible. These can change, and some disorders do come and go. But making a more serious diagnosis can have detrimental effects on the person. In both cases above, the person does meet the criteria as based in the Diagnostic and Statistical Manual of Disorders. Is the DSM political? Sure thing! Running away from slavery used to be a disorder. I’ve seen the same with Pedophilic Disorder where politics drives the science, as it has in the past with PTSD and ADHD, but it’s the best we got because humans are sloppy creatures.
Those reading your article may not distinguish between a psychiatrist and a psychologist/therapist. I do not prescribe medication, only a medical doctor or nurse (psychiatrist and psychiatric nurse) can do so, as you know. But I don’t just do “talk therapy,” which can be very helpful, especially for people that have had a lot of trauma. But it takes years and years. We also do evidence-based (proven) therapies such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy and others like EDMR.
I specialized a good deal in sex therapy (paraphilia), but we hardly study sexuality in the U.S. In fact, I work with sex offenders and the myth is that they have high offense rates. For confirmation, look at the Association for the Treatment of Sexual Abuse (I am a member). No they don’t. They have the lowest offense rates of any one but murder, at about 2.5% (re-offense) because, in part, our programming works. To demonstrate the complexity, however, their recidivism rate is higher, about 11-12%, but that is not a sex offense. They get a DUI or use drugs and get sent back to prison. Many of these guys get falsely labeled as having Pedophilic Disorder because they have an offense with someone under 12, but they don’t meet the majority of the criteria (crime of opportunity ring a bell?), and the State, not the psychologist has the last say, so the diagnoses can be totally messed up. Clinicians cannot do that much about it in these cases.
Your claim seems to be that clinicians are simply over diagnosing and over prescribing medications. Yes, BOTH, as you claim ARE TRUE. I’ve seen clinicians give a Bipolar Diagnosis to kids at 12. Kids’ brains are still under construction. That is egregious. We have a saying, “We don’t cure the disease called adolescence.” The DSM criteria make this clear as well, but remember that many clinicians are being pushed my the insurance industry to put in diagnosis.
Many have written that ADHD is being over diagnosed. And if you look at the current criteria, it is difficult to make the diagnosis. There is quite a lot of criteria. And, I think, many kids are just being kids. Some are more active than others; however, I do believe that ADHD is real. It’s just being over-diagnosed.
My issue is that you do not give the whole, more complex picture, so it appears as if it’s manipulated. If we cut this insurance, the problem is that we cannot give treatment to the people that need it most.
2. The numbers have gone up because people now have access to care that they never had before, so there will be more diagnoses, more medications prescribed, and not all of it is because kids and adults are being over diagnosed. Some of them are, but why get rid of the baby with the bathwater? Many are also being helped, and now our county is facing the reality that the schools will lose the therapists they just started getting due to budget cuts. When you talk about cutting insurance, the effects could be devastating. We just witnessed another star likely commit suicide. We are seeing kids as young as 9 killing themselves. An 11-year-old girl just killed herself in Texas because kids were allegedly telling her that her parents were going to get deported and she’d be alone. COVID disrupted people’s lives and took them. This has a major impact on all of us, kids included. Many therapists actually make low pay and face administrative pressure and burnout fatigue, being forced to carry huge caseloads. Such increases the likelihood of mistakes.
When you have “toughen up” in your title, what do you suggest? We punch a kid in the face and tell HER to MAN UP? So, yes, excuse my anger at your post because you are being very insensitive to the level of suffering we all are facing. It’s fine being tough, but being tough is not being cruel. Just like there is no respect in fearing another. Kindness and toughness do not need to be contrary.
3. There are many variables you don’t include. Insurance gave people access, so they got care. But if we cut what you want, then kids and adults can only go to private practice. Session cost is outrageous, anywhere from $100-350 per session. Often intakes are more expensive. Private practice follows less stringent criteria than state agencies or public ones. That’s good and bad. Few can afford private practice, so numbers would decline. Demand for medication would drop and the “over-diagnoses” would drop significantly. But the hell that would unleash on those of us that are not tough enough could be catastrophic.
The current administration has so far shown no kindness or mercy, no humanity whatsoever. The programs they are cutting to date are those that people, working class people, need. That included the many government employees that suddenly have lost their jobs, no fault of their own. Such will only increase anxiety, depression, adjustment problems, and substance use for them, their families, etc. The United States government is not a business. It’s a country owned not by Musk or Trump but by all people, regardless of their political stripes.
And that is my fourth point. We have many prescribed drugs now for those with Substance Use Disorder. The illegal synthetic drugs are horribly potent. Just touching a school bus seat with a tiny bit of fentanyl can kill a teenager or child. Cutting funding and access to people now will in no shape or form make us tougher or more functional.
Back when you and I lived with our parents, most of our parents had secure jobs. They stayed at one job, and though not rich, they had money. You know, then, like I do that security is fundamental to human functioning. But now people have no job security, poor wages, long hours, and little hope for the future. Few will ever retire. Almost all our wealth goes to the upper 1% or .1%. This, in my opinion, is what is causing high divorce rates, increases in substance use, child abuse, mental health disorders, etc.
It’s a complex and difficult picture. This problem comes from the top; powerful rich people that only want to be richer and refuse to be just a little less rich for the benefit of the society. Nor will they control their selfishness. That is on full display. We used to love our country AND our people. This is not simply an issue of clinicians abusing a medical model. I, too, have written on why I left positions because I felt I was being pushed to do Medicaid fraud by giving kids more appointments than was necessary. I quit, didn’t do it. In fact, many agencies, get paid a lot more with Medicaid than a private practice, so many opportunist set up shop to exploit kids in the name of helping them. When I worked at one such place, shareholders was the focus, not kids. We were told to run groups with one or no child in them so that we could collect grant money. When they published a white paper proving that their groups worked, they left out the fact that there was only a few kids. That is not a study. It’s a lie.
It’s not a matter of taking funding away. Insurance companies have to be held accountable just like clinicians and agencies do. If lawmakers listen only to your argument, millions of kids will suffer, and I have little doubt that suicide rates among kids will skyrocket. Is that want you want? Regardless, I bet what you want will happen.
Yes, Dr. Vatz, the society creates many of the disorders we face, and it’s much more complex than a medical diagnosis, but what people are suffering from is real.
You have no idea what you are writing about. No qualifications whatsoever … this is not commentary; it’s manipulation. We are not playing debate; you are playing with people’s lives.