More than ten years ago, a major milestone in the treatment of mental health disorders was reached when President George W. Bush signed the Mental Health Parity and Addiction Equity Act (MHPAEA) into law. The legislation, commonly known as the federal parity law, requires most insurers to cover illnesses of the brain, such as depression or substance use disorder (SUD), just like other illnesses of the human body, such as diabetes mellitus or cancer.
“Sadly, the promise of the parity law has gone unfulfilled. Access to care remains elusive for millions of Americans while deaths from drug and alcohol misuse, as well as suicide, have skyrocketed,” wrote Patrick Kennedy and Benjamin Miller on Stat on the tenth anniversary of MHPAEA in October.
Analysis conducted by the Kennedy-Satcher Center for Mental Health Equity in 2018, gave 32 states a failing grade for their parity statutes. Only one state, Illinois, was awarded a grade better than C!
“Strong state parity laws are one of the critical foundations for ending discrimination in the coverage of mental health and substance use disorder services,” wrote Kennedy and Miller. “Without such laws, it’s basically a lottery as to what type of care a person might receive.”
“The laws have been partially successful,” concluded Graison Dangor somewhat more positively for Kaiser Health News in June. “Insurers are no longer permitted to write policies that charge higher co-pays or deductibles for mental healthcare, nor can they set annual or lifetime upper limits on how much they will pay for such care. But advocates for patients say insurance companies still interpret mental health claims more stringently than those for physical illness.”
And they seem to have found rather creative ways to circumvent the mental health parity mandates. In an article for Stat, Jack Turban explained how some insurance companies apparently employ “ghost networks” of psychiatrists to impede patients’ access to care by listing incorrect contact information for their in-network providers.
“Maybe insurance companies don’t know their lists are inaccurate. Maybe they do but choose not to do anything about it,” Turban wrote. “A more alarming possibility is that some companies intentionally keep the lists inaccurate to save money by preventing access to mental health care. After all, ghost networks benefit insurance companies: If it’s hard to find a provider who takes your insurance, it’s less likely you will access services that the insurer will have to pay for.”
Whatever is going on here, the end result is patients don’t get the treatment they require. “While we have made some progress on getting more people with SUDs to treatment; there remains a large gap in treatment need vs. treatment access,” reported the federal government’s Substance Abuse and Mental Health Services Administration in its latest National Survey on Drug Use and Health. The survey further reported that “transitional age youth (18-25 y) have increasing rates of serious mental illness, major depression, and suicidality.”
Most of them do not receive the treatment they need, nor does a majority of any age group. According to the National Institute of Mental Health, the percentage of young adults aged 18-25 years with any mental illness (AMI) who received mental health services was at 38.4 percent considerably lower than for adults with AMI aged 26-49 years (43.3 percent), and aged 50 and older (44.2 percent).
Parity for mental health and addiction has been the law of the land for over a decade now. Real parity is not that complicated to achieve and yet its implementation is still lacking. America is going through unprecedented suicide and addiction epidemics—which makes realizing parity of paramount importance.