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Jeffrey A. Lieberman, M.D. Headshot

First Step Toward Mental Health

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Friday, Nov. 8 marked a milestone that countless American families never thought they would see: The Obama administration released the final rule for enacting "mental health parity," requiring that insurance companies cover the treatment of mental and substance use disorders at the same level as all other illnesses. Never before have we been so close to ending discrimination and achieving equal rights for the millions of people with mental and substance use disorders.

Yet as new concerns arise, we must keep our focus on this goal. USA Today's recent news coverage correctly notes that young people will likely receive more mental health care as they become newly insured under the ACA. But this point overlooks the fact that mental health parity will amount to significant savings in overall health care costs. Earlier intervention in mental health care will save taxpayers billions of dollars and could save the lives of an untold number of young people -- including many among our returning military forces whom we honored on Veterans Day.

Most illnesses have a natural life cycle when symptoms first appear, a "sweet spot" when doctors can quickly deliver the most effective treatment possible. Mental disorders usually surface in adolescents or young adults. Nearly half of all diagnosable mental illnesses show symptoms by age 18, and fully 75 percent become symptomatic by age 30. This is the crucial time to treat these disorders. We desperately need to focus on early intervention so we can identify and combat these illnesses when there is the greatest chance of success -- and limit unnecessary suffering.

Treatment certainly costs money, but studies have shown that failure to treat is far more expensive. Children and adolescents with untreated mental illnesses and substance use issues can become adults with more complex medical disorders, leading to more frequent and very costly hospitalizations. They are then far more likely to require government support through Medicaid and Supplemental Security Income, and the damage to their lives and relationships is incalculable.

This vital issue is especially poignant for the young men and women who've come home from the wars in Iraq and Afghanistan. These people who served our country face greater risks because of their age and their experiences in harrowing situations. They bear the invisible wounds of posttraumatic stress disorder and have a high risk of suicide. Our nation is coming to realize that they desperately need help, that doing nothing is no longer an option.

Providing insurance benefits for young adults may initially mean greater costs, but these would be quickly outweighed, in just a few years, by significant savings. Recent research shows that individuals with mental illnesses have far more general health problems than those without, that they are far more prone to substance use and its complications, and they die by over a decade earlier than their healthier cohorts. If we reduce the duration of untreated mental disorders, we increase people's ability to recover and to become healthy, productive citizens supporting themselves and their families. That's an investment with a solid, proven return -- an investment in our young people that our nation that we should be willing to make.

The final rule on the Mental Health Parity and Addiction Equity Act is a critical first step to ensuring every American who is in need has access to affordable, quality mental health care. Only then will we have achieved a truly equitable system, and ended the historic discrimination in mental health care.

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