The federal government "dragged the [insurance] carriers kicking and screaming" into providing federal workers the most liberal benefits for mental treatment available to any group in the country, according to Edwin C. Hustead, chief actuary for the federal benefits program in the Office of Personnel Management.
"It was after President Kennedy's statement that mental illness should be treated like any other," he said.
However, it is not easy to assess the costs of that pioneering step.
The government paid a total of $1.97 billion for its employes' health insurance premiums for 1979, but no one can say how much of that was the result of mental, as opposed to physical, benefits costs.
The closest indication comes from Blue Cross/Blue Shield, which estimates that mental health benefits have raised its total health costs by 7 to 8 percent.
Blue Cross health plans cover more federal workers (56 percent) than any other and are the most expensive. Blue Cross offers federal workes the broadest mental health benefits available to any group in the country.
The plan pays up to $50,000 a year for visits to psychiatrists or psychologists. The patient pays the first $100 and 20 percent of the costs after that, while Blue Cross pays 80 percent.
For hospital in-patient mental treatment, Blue Cross provides even more liberal coverage, paying generally the entire bill, with no deductibale and no annual dollar limit-costs sometimes as much as $500 a day in the case of someone who is deemed suicidal and provided intensive therapy.
The government pays an average of 60 percent of its employes' premiums. A bill sponsored by Rep. Gladys Spellman (D-MD.) would raise the federal share ot an average of 75 percent, "closer to what private employers provide," a Spellman spokesman said.
But the administrators of the array of more then 80 federal health benefits plans oppose the move as too expensive in an era of soaring costs and tightened purse strings.
The Aetna Life Insurance Co. had also offered broad mental health benefits but, in 1975, convinced the government to allow it to cut them back. (Aetna still provides the second broadest program of mental benefits).
Soaring costs for mental illness, far beyond what exerts predicted when the benefits were introduced, alarmed early '70s.
Aetna in 1973, for instance, was paying 12 percent of every health dollar for mental illness. This, coupled with evidence that patients with so-called trivial problems were running up high costs, and the lack of cooperation from hospitals and doctors, led to Aetna's cutback, according to federal benefits experts.
The government rejected a similar proposal from Blue Cross to reduce its mental health benefits at the same time.
"We were committed to the principle and we wanted to retain at least one plan that provided full coverage," Hustead said.
When Aetna reduced its benefits, "all hell broke loose" and an estimated 9,000 employes recieving mental treatment under the Aetna plan switched to Blue Cross, according to Thomas A. Tinlsey, head of the federal benefits program at the Office of Personnel management.
"That got the attention of psychiatrists and our professions, who feared Blue Cross would soon cut back as well," he said.
The result has been a flurry of studies, hearings and efforts by mental health professionals to make their own internal peer review system more credible to the insurance administrators.
Since 1975, the percentage of costs going for mental health treatments has leveled off, Tinsley said, but the other conflicts are still fermenting.