Former U.S. Congressman Patrick Kennedy was in South Florida last week pushing the radical idea that all people, including those with mental illness, are created equal.
What makes this idea radical in 2012 is that we continue to discriminate against the 6% of Americans who have serious mental illnesses. Patrick Kennedy understands this, and is devoting his life after Congress to fighting on their behalf.
It is a fight that affects him personally, as it does the one-fifth of all children and the one-fourth of all adults with a diagnosable mental illness each year.
Discrimination against people with mental illness takes on many forms – arrests for loitering, incarceration instead of treatment, and perhaps most commonly in the unequal coverage by insurers for mental health conditions.
This last form of discrimination was supposed to have ended with the passage of the Mental Health Parity and Addiction Equity Act of 2008. But the federal “rule” implementing this law has never been finalized.
At a field hearing hosted by Rep. Kennedy on October 9th, a speaker from the American Psychiatric Association talked about the effect this has had. In late 2011 Florida Blue (formerly Blue Cross Blue Shield of Florida) terminated its contracts with nearly every behavioral health provider in the state. Providers had to sign new contracts for significantly less reimbursement.
Before that action, a psychologist was receiving just under $52 for a full counseling session, already far less than the average hourly rates paid to carpenters, plumbers, and electricians.
After the action, the same psychologist received just $46 per hour.
The Florida insurance commissioner said that he had no jurisdiction over this.
This isn’t just Florida’s problem. I point out in testimony being presented today (October 17th) at a public hearing on behavioral health parity hosted by the Connecticut Office of the Healthcare Advocate that actions like this affect every state. Because there is no federal rule, a Connecticut insurer covering mental health care given in Florida also pays that pitiful amount – because the Florida insurer sets the reimbursement for others.
Insurance discrimination affects everyone. But people with serious, chronic mental illnesses face worse today.
As low income, single adults, they were all supposed to become eligible for Medicaid benefits in 2014 to cover mental health services. But the U.S. Supreme Court said earlier this year that states could opt out of that Medicaid provision. As homeless people, they often end up in jails and prisons because there are not enough places of care. And as returning veterans – or “returning heroes,” as Rep. Kennedy prefers to call them – they often wait months to receive treatment through the VA.
There is still another way we deny people with mental illness fair treatment for their disease – ironically, by hiding behind their “civil rights.” Local police officers and sheriffs known as mental health officers have become gatekeepers to emergency mental health services, and judges often make decisions about treatment. A mental health officer once denied my son emergency care at a time of severe crisis because he didn’t think the crisis was severe enough to “deny his civil rights” by bringing him to a hospital for 24 hours. So he didn’t get care that day.
But he was jailed six times over the next three years.
People with chronic mental illness, Kennedy noted at a reception my wife and I hosted at our home, don’t have a big political constituency.
That’s why states have been able to cut $4.6 billion in mental health funding since 2009.
We can change this nightmarish reality if we want to.
Here are just two examples of how.
In recent months my son has been involved with a behavioral health court in San Francisco. Behavioral health courts take into account a person’s mental illness in devising treatment strategies to reduce recidivism. There’s evidence that they work.
And instead of just playing catch-up long after a disease has ruined lives, we can begin with equal treatment – including parity in insurance coverage – for a set of chronic diseases that take as big a health toll each year as cancers.
Rep. Kennedy is optimistic that the tide will turn soon. He believes that this time we will not repay war heroes with neglect, and that what we do for them will lift up everyone with mental illness.
I sure hope he’s right.
Because there are elections around the corner, and something has got to change.