A Failure to Rehabilitate: Leaving Disability Insurance Out of the Mental Health Parity Debate

fromPage=onlinea see also Ronald C. Kessler et al., Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication, 62 ARCHIVES GEN. PSYCHIATRY 593, 596 (2005), available at http://archpsyc.jamanetwork.com/ article.aspx?articleid= 208678 (finding that nearly half of Americans will meet the criteria for a mental health disorder at some point during their lifetime). 35. See U.S. DEP’T OF HEALTH AND HUMAN SERVS., MENTAL HEALTH: A REPORT OF THE SURGEON GENERAL 6 (1999) [hereinafter SURGEON GENERAL’S REPORT], https://www.surgeongeneral.gov/library/reports/ (noting that rapid urbanization in the early 19th century encouraged creation of isolated asylums for the mentally ill, a social policy later abandoned during the deinstitutionalization movement of the 1950s). 36. See Bernice A. Pescosolido et al., “A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence, 167 AM. J. OF PSYCHIATRY 1321, 1325 (finding “no reduction” in the stigma surrounding mental illness, despite wide public acceptance of neurobiological theories and support for treatment, including psychiatry); see also NAT’L INST. OF HEALTH, THE SCIENCE OF MENTAL ILLNESS 21 (2005), available at http://science.education.nih.gov/supplements/nih5/Mental/guide/nih_ mental_curr-supp.pdf (explaining that mental illness is associated with “changes in the brain’s structure, chemistry, and function”). 37. See Eric B. Elbogen & Sally C. Johnson, The Intricate Link Between Violence and Mental Disorder, 66 ARCH. GEN. PSYCHIATRY 152, 152 (2009), available at http://archpsyc.jamanetwork.com/article.aspx?articleid=210191 (finding that the incidence of violence in individuals suffering from severe mental illness was significantly higher only for those with co-occurring substance abuse issues). 38. See SURGEON GENERAL’S REPORT, supra note 35, at 7 (citing a 1997 study concluding that people with mental illnesses were perceived to be more violent than in similar research conducted in the past). 39. CTRS. FOR DISEASE CONTROL AND PREVENTION, ATTITUDES TOWARD MENTAL ILLNESS: RESULTS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM 4 (2012), http://www.cdc.gov/hrqol/mental_health_reports/mental_health_reports.html. 480 21 WASH. & LEE J. CIVIL RTS. & SOC. JUST. 471 (2015) on society. 40 By placing mental and physical disabilities on equal footing, parity laws help to reduce the damaging effects of stigma. More fundamentally, research into the causes of mental illness has discovered a biological basis for disorders such as schizophrenia and clinical depression, blurring the line between physical and mental impairment and calling into question the validity of the mental/physical distinction found in many disability insurance policies. 41 Studies linking mental and physical illnesses suggest that improving overall mental health may help to ameliorate common physical ailments such as heart disease, providing further evidence of the social utility of parity laws. 42 The benefits of parity legislation, moreover, are not limited to improvements in health. Nearly two-thirds of all consumer bankruptcies are directly related to illness or medical debt. 43 The proportion of bankruptcies attributable to medical causes rose by 49% between 2001 and 2007. 44 Perhaps surprisingly, most (77.9%) of those who identified illness as a contributing factor in their bankruptcy were insured at the onset of 40. See UNIV. OF TEX. MENTAL HEALTH POLICY ANALYSIS COLLABORATIVE, THE CONSEQUENCES OF UNTREATED MENTAL ILLNESS IN HOUSTON, 3 (2009), http://www.mhtransformation.org/documents/reports/external/The%20Consequences% 20of%20Untreated%20Mental%20Illness%20In%20Houston.pdf (explaining that the societal costs of Houston’s underfunded mental health infrastructure include “economic loss, homelessness, increased juvenile and adult criminal justice system involvement, and about a 25-year decrease in life expectancy”). 41. See, e.g., Elain Walker & Kevin Tessner, Schizophrenia, 3 PERSP. ON PSYCHOL. SCI. 30, 30 (2008) (“[G]radually, over the past half century, the functional-organic distinction has been abandoned, giving way to the idea that schizophrenia is a brain disorder.”). Recent research on schizophrenia’s causes suggests that the disease is heritable, and is associated with specific genes as well as physical changes in the brain’s composition and structure. Id. at 32, 34–35; see also R.H. Belmaker & Galila Agam, Major Depressive Disorder, 358 NEW ENG. J. MED. 55, 58–59 (2008) (describing the “considerable evidence” linking physical abnormalities such as elevated cortisol levels with depression and noting that antidepressant treatment resulted in reversal of some of these abnormalities). 42. See Belmaker & Agam, supra note 41, at 64 (pointing to “[s]trong epidemiologic data” linking major depressive disorder with “increased cardiovascular morbidity and mortality”). High cortisol levels from depression may increase the risk of coronary artery disease, and antidepressants have been shown to increase the survival rate of patients who become depressed following a heart attack. Id. 43. See David U. Himmelstein et al., Medical Bankruptcy in the United States, 2007: Results of a National Study, 122 AM. J. MED. 741, 743 (2009), available at http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf (finding that 62.1% of debtors in bankruptcy reported medical causes, with 37.8% blaming income lost due to illness).