This is Kevin’s story. I am forced to tell it for him for on August 9, 1997, with these last words left to us in a note: "Dear Mom & Dad, I know I told you that I would be OK but I will never be all right as long as I live with the disease called depression. I cannot go on being a burden to you both emotionally and financially, it only adds to my burden........ I love you both.", Kevin chose to end his life.

Kevin, suffered from a brain 

disease known as Bipolar Depression or Manic-Depressive Disorder. It is likely that he had it from birth or shortly thereafter for at the age of three we were painfully aware that his behavior was "not normal".  

At that time many tests and EEG’s were conducted, all "abnormal but non conclusive" and we received a diagnosis of Hyper- Kinetic and the drug Ritalin was prescribed. Although the drug did as intended and dealt with the hyperactive behavior, Kevin was thrown into a deep depression or to the opposite pole. He developed sleep disorder, rarely sleeping through the night. Years of doctors, psychiatrists and psychologists followed. A combination of drugs was found that allowed him to function fairly well and live a relatively happy childhood.

Kevin’s impulse control was never good and many decisions that he made caused distress to his father, his brother and myself. He was always our child that needed special care, love, and understanding. At the age of 17, following a bout with pneumonia, his behavior became erratic and he began to have the very high and very low moods associated with bipolarism. However, at that time there was not much known about these brain disorders and the association with his early "hyper-kinetic" behavior was not made (today studies tend to indicate that many early bipolar’s were misdiagnosed in childhood). Although blood tests proved otherwise, because he was 17, the doctors insisted that he must be into drugs or that he was just "acting out". Kevin’s mental and physical health rapidly deteriorated and he spent several months in a private mental facility and local hospitals. It was not until he attempted "to make himself well" by overdosing on his prescription medications did the correct diagnosis come about. This rapidly led to a specialist in depression who started him on Lithium and his life again turned around. He was able to attend college and earn an Associate degree in machine tool and die making. During these years Kevin, being a minor, was a beneficiary of the health insurance plans of my husband and myself. We were very grateful for, even then, the medical bills were enormous. Kevin’s hospitalizations and medications were covered and we were able to secure college educations for both of our sons without sinking deeply in debt.

Bipolar depression is a cyclic disease. Not only does the patient have highs and lows often in the natural course of the day, month or year, but there are certain times in their lives that crisis episodes can occur. We were warned to watch out for increased symptoms in Kevin’s "early thirties". Thus we were aware that Kevin was at risk but we never knew just how much. We never knew that as many as 30% of manic depressives carry out a successful suicide or that it is estimated that 50-60% make an attempt, that indeed it is a fatal disease. We did not know that each new crisis episode is deeper and longer than the one before. And we did not know that the labor and insurance industries in their attempts to cut costs would do so by limiting the amount (either by the amount of dollar coverage or by the limit of days of treatment allowed ) of coverage for mental related illnesses. So when the day came that we once again realized that Kevin (now 29) was slipping into another crisis we began to fight for his sanity, not even thinking that it would mean his very life.

Although Kevin had already been diagnosed Bipolar, due to the fact that he was covered by a Health Maintenance Organization, he was not able to seek out the doctors that he had previously been associated with. Time elapsed while he was evaluated and assigned to a psychiatrist that did not know him. New drugs have been developed but some experimentation takes place before the correct combination and dosage is found. Kevin was rapidly getting worse and in November of 1997 we found him with a loaded gun and found it necessary to have him committed to the stress unit. Up until he started this slide into depression, Kevin was working steadily. He had health care insurance that had served him well through a serious motorcycle accident and several knee surgeries. But now when he needed it the most he was "allowed" seven days of inpatient care and another three weeks of an out-patient program where he spent from 9:00-3:30 at the hospital in therapy and drug stabilization. He began to make progress in this program and we were all hopeful that he could soon return to work. On Friday of his fourth week he was told that he had reached his insurance limit and not to come back on Monday. He was assigned to a psychiatrist to monitor his medication monthly. Kevin tried to live with this but began to backslide immediately. Approximately two weeks later we got a call in the middle of the night. He was in crisis and, not knowing where to turn we drove him to the hospital emergency room. All ER personnel and the attending physician in the stress unit agreed that he should be hospitalized. A call to the insurance company and he was denied admittance. Promising that he could come back the next day for the day program they convinced him to return home and we spent an uneasy night. The next day we drove him back for the promised treatment. He was allowed to remain one day (for which he was subsequently billed) and was again denied insurance coverage. We at this time found a psychologist to work with him but at $100.00/hour, and medications of $500.00/ month the bills began to mount. It just wasn’t enough and the stress of financial bankruptcy only added to Kevin’s mental burden and lack of self worth. He never recovered. The next few months were up and down. His employer was forced to let him go and although he was able to secure another position he did not work long enough to establish insurance coverage. At the end of July he again became unstable and continued the downward slide until August when he made the decision that would free him forever.

As I work with the Partners for Parity I often hear "Parity (for mental illness and addictive disorders) costs too much". I look at what the lack of parity has cost. It has cost me my son and many other sons, daughters, husbands, wives, brothers, and sisters. We know that treatment works and that medications are being improved every day. Patients, like Kevin, are being denied the means to get well. They are being discriminated against because their illness is one of the brain and not one of the heart or lung or limb. Only God knows if Kevin would have recovered completely but I know he wasn’t given the chance.

Although Gary has coverage for health care through his place of employment, psychiatric coverage under his policy is limited. His wife was hospitalized for three weeks in 1992, during which their $25,000 lifetime coverage for mental illness ran out, leaving them with a debt of $20,000. "It wiped out my life savings" and it took an additional seven years to pay off the debt.

The next time hospitalization was necessary, the debt from the first hospitalization was not yet paid off. According to Gary, "this time it ruined my credit rating." He was unable to secure a conventional bank loan, and was forced to refinance their home at a much higher rate of interest.

"I was brought up to pay my bills and not run from things," Gary said, but the debt was overwhelming. Because his credit rating was affected,  he was unable to get financing on the purchase of a car, his credit cards were worthless, and he was harassed by bill collectors at work and at home. He tried to get supplemental insurance coverage, but found that this would cost up to $10,000 a year while he was still struggling to pay not only the current debt, but also the cost of continuing medical care.

At this point Gary was receiving letters threatening to take him to court. He realized he was at risk for losing everything. When asked what will happen if there is another hospitalization, he replied: "It is always in the back of my mind. I don't know when it's going to happen, and if it does I will have no choice but to file for bankruptcy." He adds that the worst part of the whole experience has been struggling with the insurance company. Yet the cost of insurance parity is "cheap compared to the human toll."

For most marriages, this kind stress eventually results in divorce. For Gary this is not an option. He continues to live modestly, gradually paying off the debt and hoping that another catastrophic hospitalization is not in their future.

Manic depression, or bipolar disorder, is a biological brain disorder that is characterized by severe, often debilitating mood swings. This disease profoundly affects cognition, personality, judgment, and sleep patterns. Common symptoms of mania include elevated and expansive mood, increased energy, decreased need for sleep, rapid speech, reckless behavior and irritability. In its most extreme forms mania may include violent agitation, delusional thinking and hallucinations. The symptoms of depression are perhaps best described by the author Virginia Woolf in her diary: “Instead of the light of ineffable revelation I seem to be in perpetual fog and darkness. I cannot get my mind to work; instead of associations “clicking into place” everything is an inextricable jumble; instead of seeming to grasp a whole, it seems tied to the actual consciousness of the moment. The whole world of my thought is divided into incomprehensible watertight compartments .I could not feel more ignorant, undecided or inefficient. It is appallingly difficult to concentrate and writing is pain and grief to me.” 

I was diagnosed with bipolar disorder when I was in my early twenties. I am fortunate that, despite my illness, I was able to complete my engineering and law degrees and have worked as an environmental consultant for the past fifteen years. Still, it is a struggle everyday to manage my illness and the side effects of the medication that I take to control my symptoms. 

 Health insurance discrimination is putting everything that I have worked hard for my whole life in jeopardy. Five years ago I experienced an episode of severe depression as the result of medication breakthrough and the stress of working seventy hours a week. I needed to be hospitalized because I was extremely suicidal. After five weeks in the hospital I was discharged against the vehement protests of my psychologist because the hospital was concerned that I had exceeded my $2,500 per year inpatient insurance cap and that I was at the limit of what I could afford to pay out of pocket. That night I tried to kill myself and I am only here today because a friend was concerned when she could not reach me. To add insult to injury, I was left with $70,000 in uncovered bills. 

I recently started a new job with a small firm (less than 15 employees). The owners know that I am concerned about mental health care coverage so they tried to find a policy that did not discriminate against persons with mental illness.  After reviewing numerous policies my employer found that they all severely limit mental health care coverage. The policy that my company chose has a $500 annual outpatient cap, a $2,500 annual inpatient cap, and a $10,000 lifetime maximum. I feel like I have been handed a possible death sentence. I am not sure what I will do if I have to face another episode of suicidal depression with the choice between death and bankruptcy. I have to work so hard to manage my illness and it does not seem fair that my insurance will cover a brain tumor but not a biochemical imbalance. 

This blatant discrimination has no medical basis. Mental illnesses like schizophrenia and bipolar disorder are biologically based brain disorders just like Parkinson’s disease. Mental illnesses are very treatable. For example, the success rate for angioplasties is only 52% while the success rate for major depression is 80%. Can you imagine an insurance policy that limits cardiac care for males over 40 to a lifetime limit of $10,000? 

The cost of untreated mental illness is extremely high. The death rate for untreated depression is 15%. A recent study by the University of Michigan found that the direct and indirect costs of untreated depression in the workplace add up to $44 billion per year. That works out to about $3,000 per year per employee and includes factors like lost productivity and absenteeism. The cost to small and mid-sized employers is particularly high when each employee brings a unique skill to the job and the labor market is tight. 

Contrary to the horror stories published by the Michigan Chamber of Commerce and Blue Cross/Blue Shield, parity will not cause insurance rates to skyrocket or employers to drop insurance altogether. Twenty-eight states have enacted some form of mental health parity legislation and so far it seems to have had a negligible effect on premiums. In fact, Blue Cross/Blue Shield lowered its premiums to small businesses by 5 to 6 % the first year after parity was passed in Minnesota. A 1998 actuarial analysis conducted by Coopers & Lybrand for Michigan Partners for Parity predicts that the average net increase to a small employer in Michigan would be less than 3 cents per hour for an employee with two dependents. Some HMOs are beginning to recognize that parity will not adversely impact premiums. In a letter to California Assemblywoman Helen Thompson regarding California’s recently passed parity law, an executive from Kaiser Permanente, one of California’s largest HMOs, stated that mental health parity “would not disproportionately impact our individual and small group employer products”. Kaiser predicted that any additional costs “would spread evenly across our product lines”. 

If I had been born a generation ago I would have probably died young or lived in an institution. Instead with the help my family and friends, medication and a great therapist I am living the American dream; I completed graduate school, I have a professional job and own my own home. The progress that modern medicine has made in the treatment of mental illness is nothing short of remarkable. It is unconscionable to continue to allow insurance companies to discriminate against persons with mental illness. It is time for Michigan to join the twenty- eight other states that have enacted parity legislation.

I am writing on behalf of Parents who have Children with Mental Health Issues. My son was diagnosed with a mental illness when he was 16 years old and was very much in need of services for his mental illness. I believed at the time that I had some of the best insurance coverage in the state of Michigan, but I soon discovered that this wasn't true. This was a very difficult time in my life and also in my son's life, and the last thing I wanted to worry about was if my insurance would pay for, or even approve, services that my son was in need of.

At the age of 16 my son was trying to end his life. After numerous attempts to end his life it was approved for him to be hospitalized. This hospitalization was very short; he had stayed the maximum amount of time allowed. Ten days after being released from the hospital he again attempted to end his life, so a second approval was given for hospitalization. During the entire time I had to fight for him to be able to stay in the hospital longer than what the insurance company thought was necessary. What a horrible time this was. As a parent there was nothing I could do to make my son better, and I also had to think about giving up my rights as his Mother so he would get the care that he was in need of. Than when things were getting better with my son, the bills started to arrive; my portion of one of the many bills was over $40,000.00. So now my son and I were also looking at a situation of having to sell our home to pay this one bill and risk the chance of being homeless.

Seven years later my son still struggles with his illness, and with insurance companies to approve the care that he is in need of. He is a contributing citizen to society, but is still discriminated on the mental health care that he is in need of. Parity would help stop this discrimination that affects not only my son, but all of the sons and daughters who struggle with Mental Illnesses.

Thank you for your support on Parity and for hearing my family's continuing struggles on this matter.

 My primary psychiatric diagnosis is bipolar disorder. I will share my story about how the lack of insurance parity has adversely affected me and my family. Also, I want to tell you that my personal case is not uncommon. Lack of insurance parity for mental illness, or discrimination by insurance companies, affects a huge number of individuals and families who go without mental health services because of the inequity of insurance coverage, or have to settle for the sub-standard care they can afford.

Currently, I am covered under my husband's large group employer insurance plan with BCBSM. If I fell over right now and had a heart attack, my insurance would cover my bill 80% and I would have to pay 20%. If I need treatment or hospitalization for my organic brain disorder, my insurance will only cover 50% of the bill, leaving me and my family owing the remaining 50% of the bill. This is clearly, blatant discrimination against me and my family. The last time I used my insurance for mental health services, other than prescriptions, I had to set up a payment plan with the hospital, which I could not keep. They eventually wrote-off the bill and that is now ruining my credit rating.

I go to see my psychiatrist once every 3 months instead of monthly, which he would prefer, but I cannot afford to pay him monthly. I had a balance with him for over 2 years, and I finally was able to pay the balance by borrowing money from my in-laws, which lead to another whole set of problems. My psychiatrist charges me on a sliding scale, but I still struggle to keep a zero balance with him. I do not submit my psychiatrist's office visit bills to my insurance company because they would count against my lifetime maximum coverage of $30,000 for mental health. My policy's lifetime maximum coverage for physical conditions is $5,000,000. Those numbers speak volumes by themselves. But, I always think, "what if I need to go into the hospital again and need even the 50% coverage"?

It is unfair and illogical that myself, and so many other people are discriminated against because we happen to have an organic disorder of the brain instead of any other organ of our bodies. In many cases, this is discriminating against people who cannot speak for themselves or stand up for their rights because of these debilitating, yet treatable disorders. I'm sure that you've heard the expression "kicking someone when they are down." Lack of insurance parity does this over and over again every day. I am asking for myself, my family, and members of my support group that you help Michigan adopt parity law. By doing so, you will end this discrimination against me, and make me proud to live in the State of Michigan.

 

I started advocating for parity about 10 years ago after my experience with the inequity of mental health insurance coverage. I was employed as a R.N. & experienced severe depression during 1996 that required outpatient treatment and hospitalizations on a psychiatric unit. My insurance required 50% co-pay for both outpatient and inpatient mental health treatment.

It was difficult for the psychiatrists to find an effective combination of medications to treat my depression. My symptoms increased and became so severe that I was not able to work. This resulted in several medical leaves of absences during 1996. Being responsible for 50% of my inpatient hospital bill made things much worse. I did not stay hospitalized on the psychiatric unit as long as my doctor recommended because of the prohibitive cost. Less than 2 weeks later I was readmitted because I was suicidal.

My last medical leave of absence was without pay. Eventually I had to resign from my position because it was not known when I would be able to return to work. I exhausted all of my savings and I had to cash in my retirement plan. Also, I had used up all on my out patient mental health coverage. This further increased my depression & caused severe anxiety.

After exhausting my mental health coverage & becoming financially destitute, I began receiving mental health services from a Community Mental Health (CMH) provider. I was on the verge of becoming homeless. Mercy Network-West linked me with a subsidized housing program & assisted me with applying for Medicaid, food stamps & Social Security Disability.

If I had a stroke or some other "physical illness" I wouldn't have been expected to have a 50% co-pay for medical care. What other medical conditions are required to pay for half of their hospitalization cost? Unfortunately, because of ignorance about mental illness & the stigma, treatment for my biochemical "brain disorder" was inadequate. With adequate treatment I may have been able to return to work.

Over the years I have written to many elected officials about the need to have parity for mental health insurance. Recently I e-mailed Senators Stabenow & Levin to thank them for co-sponsoring the national Mental Health Parity Act (S. 558 of 2007). Also, I would like to thank Michigan Partners For Parity for its hard work on this issue.