AA345438-C833-44C0-B24C-8796652D69E1BY LUKE MELONE: It is two p.m. on a Saturday afternoon and against my better judgment, my channel surfing lands me on TLC, formerly The Learning Channel. The hashtag in the corner of the screen reads #Hoarding, and the show’s actual title is “Hoarding: Buried Alive.” Like a modern day purveyor of human oddity sideshows, TLC has built its brand around reality shows that highlight the weird, unusual, and mentally ill. Unfortunately, its neighboring network, A&E also has a show on hoarding aptly titled “Hoarding.”  Both of these shows appear to be immensely popular based on the number of seasons aired: “Hoarding: Buried Alive” is in its seventh season and A&E’s “Hoarding” in its sixth season (by comparison “Breaking Bad” lasted five seasons). The shows are also responsible for sparking a cottage industry in home de-cluttering services.[1]

If you are fortunate enough to avoid reality shows or know no sense of hoarding, referred to as hoarding disorder (HD), can be characterized by an abundant collection of things –anything from household appliances to pets- and the inability to throw any of it away. The cluttered items pile up in rooms, often causing doorways to be obstructed or fully blocked, which can pose a fire hazard. Also, often depicted on the shows, discarded food waste can also be a part of the clutter, which can lead to incredibly unsanitary living situations.

Scientific American[2] reports that between five to 14 million people are afflicted by hoarding disorder in the United States. The recently released fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included an independent diagnosis of HD newly separated from being listed as a symptom of obsessive-compulsive disorder (OCD).[3] The disorder’s unique characteristics and treatment methods were cited as reasons to warrant the distinction. The new diagnosis will help physicians better identify the disorder and provide broader awareness. Furthermore, according to a 2011 study by researchers at Smith College,[4] individuals suffering from HD often exhibit signs of other mental illnesses including major depressive disorder and social phobia.

In the wake of mass shootings, mental health always becomes a hot topic. It is splashed across the front pages of newspapers, news pundits cannot stop talking about it, and countless bloggers are scribbling their views on it. Arguably for some, talking about mental health is simply a way of deflecting the conversation from gun safety.[5] However, having the topic of mental health in the national discourse is no doubt a step in the right direction. Secretary of Health and Human Services, Kathleen Sebelius, still under fire from the Healthcare.gov rollout, recently announced new rules for the inclusion of behavioral health coverage through private plans. In 2008, President George W. Bush signed The Mental Health Parity and Addiction Equity Act,[6] which required insurance plans to cover mental health as equally as physical health. However, due to little oversight and enforcement, many insurance plans continued to offer poor mental health coverage. The new regulations, promoted by Sebelius, will substantially require insurance companies to offer equitable co-pays and deductibles to both physical and mental health.[7] The new rules are expected to impact around 85 percent of Americans who have private health insurance.

Medicaid is currently the largest payer of mental health services in the country. Under the Affordable Care Act, Medicaid expansion would have covered up to an additional 30 million Americans. However, 26 states rejected the measure to expand Medicaid, which leaves approximately 5.2 million[8] potentially Medicaid-eligible individuals uninsured next year. While some politicians champion greater access to mental health services as a deterrent to gun violence, it is often those same politicians who are reluctant or out-right refusing to expand mental health coverage.

It is 2:30 p.m. now and I’ve shut off my television, unable to further endure the capitalization of the mentally ill. Perhaps as we embark into the future where mental health coverage is equitable to physical illness coverage and where Medicaid coverage is significantly expanded to include millions of more Americans, cable networks will have a more difficult time finding people who suffer from hoarding disorder for multiple seasons of television.

Luke Melone is a Master’s of Public Administration candidate specializing in Health Policy & Management. His areas of interest include domestic and international health policy analysis. Prior to attending NYU Wagner he received his B.S. in Health Services Administration from the University of Central Florida. He recently completed a graduate internship in the Department of Economic and Social Affairs with the United Nations. 

[1] http://www.post-gazette.com/businessnews/2012/07/01/TV-show-Hoarders-has-helped-create-an-industry-cleaning-up-filthy-hazardous-homes/stories/201207010157

[2] http://www.scientificamerican.com/article.cfm?id=real-world-hoarding


[4] http://www.ncbi.nlm.nih.gov/pubmed/21770000

[5] http://www.nationalreview.com/corner/358680/can-we-talk-about-mental-health-now-jonah-goldberg

[6] http://www.dol.gov/ebsa/newsroom/fsmhpaea.html

[7] http://www.nytimes.com/2013/11/08/us/politics/rules-to-require-equal-coverage-for-mental-ills.html?_r=2&

[8] http://www.kaiserhealthnews.org/Daily-Reports/2013/October/16/reform-medicaid-expansion.aspx