How the disease model helps and hurts mental healthcare
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Mental health and addiction crises rage on in the U.S., destroying people, families and communities nationwide. Still, the vast majority of those who could benefit from treatment do not receive it. A major barrier to behavioral healthcare access has been financial and the unwillingness of insurance companies to pay for the high costs of treatment for addiction and mental illness.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted in 2008, requiring health insurance companies to cover behavioral healthcare with benefits on par with medical or surgical care. Despite this legislation, many people still do not receive treatment for mental illness and addiction. Those who do receive treatment often have to fight with their insurers or go into crippling debt.

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The recent passage of the 21st Century Cures Act will hopefully improve the parity problem by toughening enforcement of parity laws. This sweeping legislation (HR 6, HR 34 and related bills) will serve many purposes, the following of which pertain to parity:

  • Develop a new federal guideline for compliance with parity laws

  • Improve federal and state coordination with regard to parity compliance

  • Release annual reports of all closed federal investigations of alleged parity violations

  • Require the Government Accountability Office to study enforcement of parity laws and make recommendations for improvement

  • Develop new resources and educational programs to ensure that parity applies to those with eating disorders and other serious mental illnesses

The 21st Century Cures Act contains many other provisions related to all aspects of mental healthcare, research, education and criminal justice.

Examining the underpinnings of parity

Implementing parity laws has been as difficult as establishing the brain disease model as an accepted approach to addiction and mental health.

Part of the rationale for parity legislation is based on the idea that behavioral disorders are caused by neurobiological dysfunction. Mounting scientific evidence has demonstrated that mental illness and substance use disorders are caused by disruptions in the neural circuits. That evidence has led to a disease model of psychiatric and addiction treatment. Ideally, recognition of the biological aspect of behavioral disorders should allow people to receive help for their conditions with dignity and respect rather than with blame and persecution.

Learning from the experience of others

Psychiatric and addiction treatment clearly does save lives in many cases. Mental health parity does improve the chances that those who are affected can get the help they need. However, some say that equating mental illness as a chronic brain disease risks unnecessary harmful treatment, discrimination, stigma and abuse.

For example, psychiatric persecution has reportedly been used to force treatment on and discredit political dissidents in Russia. Furthermore, Russians who have been treated for mental illness or addiction can never legally possess a firearm again, despite the fact that the majority of mentally ill are not violent.

Moving behavioral healthcare forward in the 21st century

Defining normal behavior is obviously challenging because of the complex nature of the human mind. Even the American Psychiatric Association met quite a bit of controversy when they revised and published the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. There is currently no blood test or other biological marker to determine whether a person is mentally ill or not. As a result, under-diagnosis, misdiagnosis, and over-diagnosis can happen. Mentally ill patients, their families and healthcare providers must be vigilant to the systemic pitfalls of behavioral medicine and to ensure ethical standards and quality care.

In addition, oversimplifying behavioral disorders as merely a brain disease leaves out critical effects of behavioral disorders that must be addressed for treatment to be successful. For example, the American Society of Addiction Medicine defines the complex problem of addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.” Treatment must, therefore, be aimed at restoring all of these areas to health.

Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health, a behavioral health treatment provider with locations throughout the United States. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. Follow us on Twitter.


The views expressed by contributors are their own and not the views of The Hill.