Pubdate: Wed, 11 Apr 2007
Source: New York Times (NY)
Copyright: 2007 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Maia Szalavitz
Note: Maia Szalavitz, the co-author of "The Boy Who Was Raised as a 
Dog: And Other Stories From a Child Psychiatrist's Notebook," is a 
senior fellow at Stats, a media watchdog group.
Bookmark: http://www.mapinc.org/topics/addiction
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

WHEN THE CURE IS NOT WORTH THE COST

ON its face, providing equal coverage for mental and physical 
illnesses sounds like a good idea, something only a managed-care bean 
counter could oppose. To that end, Representatives Jim Ramstad, 
Republican of Minnesota, and Patrick Kennedy, Democrat of Rhode 
Island, have introduced the Paul Wellstone Mental Health and 
Addiction Equity Act.

Named for the senator who was long an advocate for mental health 
"parity," it would require that private insurers pay for as much 
treatment for mental illnesses and addiction as they do for physical illnesses.

Senators Ted Kennedy, Democrat of Massachusetts, and Pete Domenici, 
Republican of New Mexico, have introduced a similar bill in the 
Senate. President Bush has said he will sign the legislation if it passes.

Unfortunately, this change would not be as benign as it appears. 
Unless mental health parity is tied to evidence-based treatment and 
positive outcomes, generous benefits may become a profit bonanza for 
providers that does little to help patients.

Thanks to research by the National Institutes of Health and academic 
scientists during the last three decades, we now have proven 
treatments for depression, addiction and other mental disorders. But 
all too often clinicians do not use them.

Without financial incentives to provide treatments that are known to 
work, many mental health professionals stick with what they know, or 
pick up on the latest fad, or even introduce their own untested 
innovations - which in turn are spread by testimonials and credulous 
news media coverage.

Take the well-known approach featured on the cable TV reality show 
"Intervention" aimed at getting addicts and alcoholics into 
treatment. Here, the family and sometimes the employer gather with a 
counselor, confront the addict and threaten to shun him or fire him 
if he doesn't enter a rehabilitation center. A 1999 study compared 
this style of intervention - which can backfire and lead to broken 
families - to a less confrontational approach known as "community 
reinforcement and family training," which is aimed at helping the 
family nurture the addict's own motivation.

More than twice as many families succeeded in getting their loved 
ones into treatment (64 percent) with the gentler approach than with 
standard intervention (30 percent). But no reality shows push the 
less dramatic method, and it is difficult to find clinicians who use it.

Similarly, one of the most common approaches to alcoholism treatment 
involves having counselors and fellow alcoholics confront patients 
and force them to identify themselves as alcoholics. But research 
finds that the more a counselor confronts, the more a patient drinks 
and the more likely he is to drop out of treatment. And no 
association between accepting the label "alcoholic" and quitting 
drinking has been found. Counselor empathy - not confrontation - is 
connected with recovery.

According to a review by the Institute of Medicine in 2006, only 10.5 
percent of alcoholics received "care consistent with scientific 
knowledge" of the disorder; similarly, 43 percent of children in 
psychiatric hospitals are given antipsychotic medication despite not 
suffering from psychosis. Tough boot camps for troubled teenagers - 
which have been proven to be ineffective and potentially harmful - 
thrive, while "multisystemic family therapy," which effectively 
treats teenagers at home, is available only through the juvenile 
justice system.

Even in general medicine, research is sometimes slow to be translated 
into practice - but mental health care is often entirely disconnected 
from evidence. Some therapists argue that the human mind is too 
complex and variable to allow for standardized treatments. But 
shouldn't they at least start with approaches known to work for the 
largest number of patients?

If we want to provide genuine help for the 33 million Americans with 
mental health and drug problems, giving more no-strings-attached 
money to providers via insurance mandates is not the answer. It is 
dangerous to blindly bolster useless and even harmful treatments 
while failing to support proven therapies. Coverage must be tied to 
outcomes and evidence. And payment should be dependent, at least in 
part, on health improvements, not just services received. We need 
parity in evidence-based treatment, not just in coverage.
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MAP posted-by: Richard Lake