Members of some area mental health organizations are warning that health maintenance organizations may be dangerous to your health, at least to your mental health.

In an action that is unprecedented in this area, and raising eyebrows even within the mental health community, the Washington Psychiatric Society and a coalition of mental health practitioners are sponsoring an advertising campaign warning that HMOs may not adequately serve mental health needs. Participating groups in addition to WPS include the D.C. Psychological Association, D.C. Institute of Mental Hygiene, Metropolitan Washington Chapter of the National Association of Social Workers, Concerned Citizens Against Drug and Alcohol Abuse and the Capital Area Depressive and Manic Depressive Association.

The coalition's ad, scheduled to run in various federal employe newspapers, warns that "HMOs say their health coverage costs less. But you may get much less, especially if you need treatment for mental illness, alcoholism or drug abuse."

The groups are especially concerned now, at the start of the annual "open season," during which federal employes may switch their coverage from one plan or HMO to another.

Standard health insurance plans have historically offered the greatest mental health benefits, but their premiums have risen in comparison to HMO premiums. "The mental health and substance abuse groups are frankly concerned that if people are thinking of transferring to an HMO or IPA {independent practice association}, they should at least be aware of the limitations of these plans," said Dr. Lawrence Y. Kline, spokesman for the WPS and an organizer of the Coalition for Adequate Treatment of Mental Illness, Alcoholism and Drug Abuse, which is sponsoring the ad.

Kline said that virtually no HMO offers more than is required to maintain its federal qualification and offers no coverage for chronic problems -- such as schizophrenia or manic depression -- and only restricted coverage of acute mental illness or drug or alcohol abuse.

Technically, to meet federal qualifications for HMOs, benefits must include up to 20 visits per calendar year for a mental health condition and up to 30 days of hospitalization per year. However, if the HMO professionals do not believe that even that much will help the condition, or if it is chronic, they may allocate fewer visits or hospitalizations or none at all. A member of an HMO is not automatically entitled to 20 visits or 30 days in the hospital.

The high option general insurance plans, especially the high option Blue Cross, offer the most complete care. Blue Cross high option covers 50 outpatient visits a year at 70 percent of "the usual and customary" costs and up to 12 months of hospitalization.

The American Psychiatric Association estimates that as many as 41 million people at any one time may be affected by some sort of mental illness, including drug problems and short-term depression. Yet, said a spokesman for the APA, "those who treat the mentally ill are finding more and more that coverage in health maintenance organizations throughout the country is inadequate."

State and local governments have subsidized mental health coverage in the past by providing help for low-cost community clinics. But in many places, these funds are becoming tighter in a period when the need is becoming greater.

Taking a cue from some other similar coalitions around the country, the area groups are urging federal employes to carefully examine mental health benefits offered by the various plans before they sign with one that "will leave them high and dry," as some psychiatrists put it at a recent meeting. Members of this group concede that activism of this type is generally foreign to the professional personality of many mental health specialists, and Kline concedes that had it not been for this public reticence, the current battle might have been joined years earlier. There continues to be controversy within the psychiatric community over how to approach the problem, but virtually all admit that the problem exists. ::

One way to assure that people are covered in the event of a mental health or alcohol crisis is for governments to make the coverage mandatory.

Opponents of such requirements say they drive up health care costs and insurance rates. Several studies, however, have shown just the opposite.

In the current Journal of Hospital and Community Psychiatry, the latest such study deals with Aetna's program for federal employes from 1980 to '83. In its study of 26,915 families in which at least one member received mental health treatment and 16,468 families in which no one did, it was found that although total costs were higher for those receiving treatment, the "costs dropped significantly after initiation of mental health treatment and continued to decline," especially in the over-45 age group.

Another recent study, published in a national insurance journal, examined the rates of 84,000 plans in six states, including Maryland, that were required to increase their mental health coverage by state or local governments. The highest resulting premium hikes were under 10 percent, and more than half the groups showed either no increases or very small ones attributable to the mandated benefits. ::

Kline has been investigating mental health care in Washington-area HMOs for several years. He has amassed a file of cases that he and his colleagues see as examples of HMO failure to perform any but the minimum mental health care services required to make them "government qualified."

What Kline and his colleagues have discovered does not seem to vary significantly in other HMOs in the country, although a few of them -- namely, he noted, one in Seattle -- are significantly above the norm.

Only a few other areas in the country, however, have seen the mental health community organize itself into what Kline admits is girding for battle.

Spokesmen for two major HMOs in this area said they were certain that none of the anecdotes contained in Kline's file of "horror stories" pertained to them. Dr. Harvey Kalin, psychiatrist, attorney and director of psychiatry and mental health care at Group Health Association, says that administration of mental health and substance abuse coverage has been reorganized -- although the benefits have not technically changed. However, he said, this has improved de facto mental health services in the year he has been there, with an emphasis on substance abuse.

Jane Galvin, who is director of contract administration at Kaiser Permanente, concedes that the mental health issue is "a hot one," but at Kaiser, too, she says, more substance abuse programs are becoming available according to internal guidelines. She refers to the mental health coalition as "the special interests who would like to see us cover psychotherapy forever." Even so, she said, Kaiser, both locally and nationally, is reassessing mental health benefits and may come up with a series of packages including some with greater benefits.

More states, too, are requiring, as Virginia did last year, that at least their own employes have plans available that include better mental health benefits. Maryland also mandates various specific types of health care in health insurance programs, but so far has exempted HMOs. The D.C. City Council passed a bill mandating the availability of health care for some city workers, but it will not go into effect fully for another four years, and even then will cover relatively few people.

"In the end," says Kaiser's Galvin, "people can select the plans that give them what they need. One of the things about free enterprise, with 40 or 50 plans, people can select what price and what benefits are best for their needs."