The Connecticut Health Foundation (CT Health) has been monitoring recent state developments intended to increase mental health parity (MHP) from both children’s mental health and health equity vantage points. The federal Mental Health Parity and Addiction Equity Act was passed into law in 2008 and promised fairer treatment of mental health and substance use disorders by requiring group insurance plans that offered such treatments to be no more restrictive than treatments offered for other medical or surgical procedures.
To date, it’s the privately insured who have faced multiple barriers to mental health care, making it something of a health equity anomaly. As the nation fully implements health reform, populations of color will gain access to public and private mental health and substance use coverage in large numbers. Supporting diverse, newly insured consumers in accessing and navigating culturally and linguistically effective mental health and substance use treatment systems that deliver on the promise (and law) of MHP must be part of the health reform equity agenda. To start, in observance of national mental health month, Daniela Giordano, Policy Director for Adults at NAMI-Connecticut (a CT Health grantee), provides an overview of the current state of MHP in Connecticut.
A story of a health crisis
Imagine your loved one has symptoms of a stroke. He gets admitted to the hospital, treated, and released. After experiencing symptoms again a few weeks later, the insurance company tells you and the treating physician that they will not pay for another hospitalization because he was just recently admitted for this type of illness. Some very limited outpatient treatment will need to do in this case. Many would consider this an outrageous response from the insurance company.
Fighting for treatment
However, this is what individuals and families face every day when fighting for treatment and services for neurological mental health disorders such as depression, bipolar disorder, anxiety or schizophrenia. Such pervasive and persistent denial of both inpatient and outpatient mental health treatment is documented well in a 2013 report by the Connecticut Office of the Healthcare Advocate. The report noted that complaints to the office about access to such services exceeded all other clinical complaints. Common and seemingly arbitrary reasons for denials include “treatment is not medically necessary,” or “due to a previous recent admission, we’re allowing only two days of inpatient stay,” or “perhaps a neighbor or family member could take care of [the patient].”
The promise of more equitable treatment by law
The federal Mental Health Parity and Addiction Equity Act was passed into law in 2008 and promised fairer treatment of mental health and substance use disorders by requiring group insurance plans that offered such treatments to be no more restrictive than treatments offered for other medical or surgical procedures. The intention of this law and Connecticut’s mental health parity law is to enhance access to effective treatment options for people with a mental illness diagnosis; these are medical, and oftentimes chronic conditions, not unlike those with hypertension or diabetes.
Mental health impacts all of us; one in four Americans experiences a mental disorder in a given year, one in five children has a diagnosable mental health condition in a given year, families are the primary care givers, and mental illness is a leading cause of disability in the United States. Nonetheless, recovery is possible so long as adequate and timely treatment options are readily available and accessible.
Connecticut has made many recent advances in implementing the spirit and practice of mental health parity. Public Act 13-3, (often referred to as the “gun bill”) was signed into law by Governor Malloy on April 4, 2013 and requires that the “clinical peer” who reviews your claim for treatment has similar qualifications to the mental health professional who prescribed the treatment. Up until now a doctor specializing in urology, for example, could make clinical judgment on mental health treatments. Now, when there is a claim for mental health treatment under peer review, it must be reviewed by a board certified psychologist or psychiatrist.
Another improvement is the inclusion of some mental health and substance use services in the “urgent care” category, thus shortening their review time from 72 to 24 hours, which means a lot when you are waiting for a decision while your loved one is in need of treatment.
The road continues
We must monitor the implementations of the mental health parity provisions of the recently passed law and continue to fill in the gaps. We need better clarity in understanding how insurance companies decide what mental health treatments are covered under their plans. We are on a promising road but need to continue advocating for fair and enhanced treatment and service options for people who are working to address their health conditions, regardless of insurance status, geographic location, age, or type of illness.