By Mickey Skidmore, ACSW, LCSW

It seemed so obvious to me …

In Gene Roddenberry’s Star Trek: The Next Generation, we see the marvelous advances of humanity. By the twenty-forth century the human race had overcome prejudice and racism; learned to nourish themselves without slaughtering animals; transcended beyond our present use of currency, and mastered the wisdom of tolerating difference — even embracing these differences for the gained strength of diversity. One obvious reason contributing to these accomplishments is no doubt having a Counselor stationed on every star ship and deep space station.

In this fictional universe, the creator envisioned leaders who valued the importance of good mental health among the people of earth. They clearly recognized the profound link between the mind and body when considering overall health, functioning and adjustment. And they understood that addressing the emotional, psychological and behavioral aspects our condition the same way physical/biological symptoms are treated, would yield tremendous benefits rippling through the fabric of our communities.

Unfortunately, the reality of American culture is light years away from these accomplishments. Despite years of national discussion and intense lobbying campaigns, we are realistically no where near “mental health parity” in our current Insurance/Managed Care system when it comes to treatment for various forms of mental illness. It is still standard procedure for many insurance or managed care companies to cover fewer visits to one’s practitioner of chose (assuming you are even allowed this consideration), and even fewer days of hospital care when patients are treated for mental illness.

If we are to realize the accomplishments of Roddenberry’s futuristic vision, perhaps the idea of parity within our present healthcare system is a reasonable beginning point. Regrettably, as we have yet to conquer greed, or prejudice, or politics, our avenues are adversarial in nature and rely on legislation forcing insurance and managed care companies to eliminate widespread limits, and restrictions for mental health care, as well as disparities in coverage for mental and physical illness under current health plans.

Opponents to this approach warn that such and idea would drive up healthcare costs. However, a closer view of today’s behavioral healthcare brings into focus some very interesting revelations:

*Insurance and Managed Care companies already impose significant restrictions and limits to “hospital care” even for the persistent and chronically mental ill. Rarely will they approve any treatment beyond medication. Thus, patients are (theoretically) placed in a safe environment where the chances of harming themselves or others are greatly reduced; they are drugged until their symptoms are more manageable; then they are released with an aftercare appointment where their medications can be managed. Some might say this is no different than stopping the bleeding in a deep gashing wound and putting a band aid on it without serous investigation to determine if other healing interventions might be indicated. You don’t have to be a therapist to see how this approach is financially inefficient, wasteful and leads to a discouraging cycle of recidivism. There is also untold cost to families, communities, and society when the mechanisms of our current healthcare industry limit the options of mentally ill patients to an endless maze of dejection.

*Despite cries of “healthcare inflation”, nearly three dozen states and the federal government have experimented with various types of parity for their own employees, and they say the cost have not been significant, with premiums typically rising less than one percent.

*It has been said in simplistic terms that there is roughly the same amount of cash in healthcare today as there always has been. Managed Care companies however, have positioned themselves as a middle layer — doling out the fees for services. Any inflation crisis in healthcare today is related more to greed than anything else. Approval for treatment sessions are reduced and fees for service to hospitals, physicians and other practitioners get smaller and smaller so the managed care companies can reap more profits.

While it is a legitimate concern to determine how such an approach would be paid for, can you imagine the multi-dimensional benefits of a culture that values the mental health of its people …

I can just fantasize about being a star ship captain in the twenty-forth century, sitting on my bridge … proud to be part of a rich heritage that had the foresight and wisdom to understand that the centerpiece of changing the entire landscape of the human race began with the attention to the mental health of everyone.

“Counselor … Make it so.”


1) Stobbe, Mike. “Workers feel rising health insurance cost.” Charlotte News & Observer, 11/11/01, (p. 1E).