The most dramatic consequences of our failed policy are seen in the mass shootings that occur with increasing frequency. However, the vastly more common experience occurs in the context of people who seek care but cannot get it. At a recent field hearing on equity in mental health care we heard the story of a young woman from Los Angeles whose insurer denied coverage for her eating disorder because, according to the insurance company, she was not 'purging enough' to warrant inpatient treatment for her bulimia. She later died of septic shock caused by her stomach rupturing after she binged. The insurance company paid for all of the emergency services that last night of care, but would not pay for treatment of her eating disorder, the cause of her death. When people are forced to jump through hoops or fail-first at lower levels of care, they often don’t persevere or obtain coverage and care in time.
We are on the brink of a great advance that began in 2008 when Congress enacted the Mental Health Parity and Addiction Equity Act to end discrimination in insurance coverage. This was a significant first step toward true equality of care. The Parity Law required comparable benefits for mental health and medical/surgical illnesses in insurance plans that provide mental health benefits. Interim Final Regulations were passed in 2010 which explained the law in a manner that should have ensured access to quality care for mental health and substance use patients. Because the Interim Final Regulations left open a few areas for study, and have not been enforced by the Administration or state regulators, some insurance companies chose to ignore them and to continue to discriminate against mental health patients. Now, five years after the passage of the Parity Law, we await the Obama Administration’s release of the “Final Rule” implementing parity.
We hope that the long-anticipated Final Rule will fill the gap left in the Parity Law so that the millions of Americans with a mental illness are no longer the subject of discrimination and abuse, and will have fair access to evidence-based treatments.
We should demand that the Obama Administration live up to its promise of quality care for those with a mental illness by vigorously enforcing the law, holding insurers accountable for providing the care patients need, and exposing those who engage in unfair and discriminatory practices.
The Parity Law and its Final Rule combined with the provisions of the Affordable Care Act provide an opportunity to rewrite, in one fell swoop, how mental health care is defined and delivered in this country. Never before have we been so close to achieving equal rights to health care for people with mental illness.
We must keep the big picture civil rights issue in sight while focusing on the practical matters of ensuring that the rights afforded by the law are provided and appealing discriminatory practices whenever they occur. We must hold the government, insurers, and providers accountable until every person who is in need has access to affordable, quality mental health care. Only then will we have achieved a truly equitable system, and ended the historic discrimination in mental health care.
Lieberman is professor and chair of Psychiatry at Columbia University and the president of the American Psychiatric Association. Kennedy, as congressman, was co-sponsor of the Mental Health Parity and Addiction Equity Act.