It has been more than 7 years since former president George W. Bush signed the Mental Health Parity and Addiction Equity Act (MHPAEA) into law. Designed to help ensure that Americans with Mental Health and Addiction issues could be assured the same access to treatment as those suffering from medical issues like cancer or heart disease. Sadly however, it seems that very little has changed since this law was enacted.
A brief search on the internet turns up an astounding number of hits related to lawsuits and legal actions alleging improper denials of treatment from insurers. This article from the New York Times in 2013 sums up the experience that many have had while trying to fulfill the promise of equity in healthcare coverage.
Things are so bad that California Senator Dianne Feinstein and 21 other senators in a bipartisan group have written to the Department of Health and Human Services (DHHS) to call for greater action and full implementation of the law. A link to the press release is available here.
So why has it been such a struggle to get this important work done? Given the recent increase in violent crime and several high profile mass shootings that can be directly traced to untreated mental health issues on the part of the shooter, one would think that this law would be a welcome addition to our healthcare reform efforts. Indeed that is how many have touted it, and what elected officials like the late Sen. Ted Kennedy had hoped for when fighting for the legislation. Yet, it has not delivered.
There are many many issues that go into understanding how we got here, but I want to touch on just two of them briefly and then leave you to form your own conclusions about how we move forward from where we are today.
1. Money, and lots of it! – Mental Health and Addiction issues are expensive to treat, and a “cure” is not easy to come by. For many people that suffer with mental illness and addiction treatment needs to be ongoing in order for them to reach success. Our medical system is not ready to embrace that concept, and insurers are terrified by the prospect that a patient may enter treatment and then need ongoing care (read cost) for an unlimited amount of time. Worse yet, relapse is entirely likely in many cases. This can mean additional inpatient stays months, or even years, after the initial care has been provided. I believe that the insurers are trying to push away these expensive new services until they can figure out how to define and quantify their exposure.
2. Stigma – We as a society have still not gotten past our centuries old fears and stigma when it comes to mental health. It amazes me how easily we separate the head from the body when thinking of healthcare. You would never tell someone with a broken leg to “suck it up and get on with your life”, yet that is exactly the feeling that many who suffer with depression, anxiety, and a host of other very real, and very debilitating, mental health issues get when they reach out for help.
Until we learn to value mental health at the same level that we do physical health, and more importantly allow those with mental health issues to receive funding for care at the same levels as those with physical ailments, we can never truly be a healthy society.