What the Hobby Lobby Decision Means for People with Mental Illness

The Supreme Court ruled 5-4 in Burwell v. Hobby Lobby that an employer does not need to cover contraceptives if it conflicts with a sincerely held religious belief. Some are saying it's a victory for religions liberty, others say it's a startling setback for women. The truth is probably somewhere in the middle. But this is a column about mental illness, and what the recent decision means for mental health consumers. In short, we're in danger.

What about Antidepressants?

Psychiatric medication saved my life. And it has saved the lives of many other people with mental illness. But there are some religious organizations that forbid the use of psychiatric medication like antidepressants. As Justice Ruth Bader Ginsburg wrote in her dissent, "Would the exemption . . . extend to employers with religiously grounded objections to blood transfusions (Jehovah's Witnesses); antidepressants (Scientologists); medications derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (certain Muslims, Jews, and Hindus); and vaccinations[?] . . . Not much help there for the lower courts bound by today's decision."

It's not just the Scientologists who forbid the use of psychiatric medication. I buried a friend who would have benefited from those medications because his church frequently preached that mental illness was demonic and the cure was a daily dose of Jesus. Medical science had no place in this church--I seriously saw them tell a woman with one leg to have faith and pray for a new one. This church and its satellite churches include several thousand people--should they be allowed to deny lifesaving medication because it conflicts with their sincerely held beliefs? Should they be allowed to refuse to hire or even fire someone with a mental illness because of their sincerely held beliefs?

Mental Health Coverage is an Uphill Battle

Prior to Obamacare, individuals hospitalized for mental illness were often denied coverage. In my case, I could not get insurance so I used up all my assets and went on Medicaid. Gina Eckart, of Midtown Community Mental Health Center in Indianapolis, once told me, “Parity for mental health and addiction treatment has been an uphill battle. Most insurance companies do not offer extensive coverage for outpatient care, requiring co-pays of 50 percent or more and limited visits. This is, of course, very different from the standards for visits to primary care physicians and other healthcare specialists."

Even the Mental Health Parity Act of 1996, which prevented insurance companies from offering lower mental health benefits than physical health benefits, did not entirely alleviate the problem. According to the Centers for Medicare and Medicaid Services, there is no prohibition against increasing co-pays or limiting visits, imposing limits on the number of covered visits even if there is no comparable limit in medical or surgical benefits, or having higher co-pays for mental benefits than physical or surgical benefits. In addition to this, there was no requirement mental health benefits were offered.

Obamacare is an effort to fix that, especially the clause that eliminates pre-existing condition denial. We, as mental health consumers, have to stay informed as to how it and future court rulings will impact us.

Why Even Birth Control Matters in This

I attend church with several people in the mental health profession. One told me that some psychiatric medications are so notorious for causing birth defects that doctors write prescriptions for birth control as standard operating procedure. Some mental illnesses are made worse by hormones--I'm an example--and birth control pills are used to manage this. There are many medical reasons for birth control. I'm one of many women who uses birth control for medical reasons. Medically necessary birth control should be covered like any other drug--period.

Ginsburg wrote that the Supreme Court of the United States may be headed into a minefield. One of those mines is treatment for mental illness. Where do we draw the line between religious liberty and medical necessity?

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