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Families still face discrimination in mental health care

By Sue Abderholden
This year, Mental Illness Awareness Week was Oct. 7-13. We celebrated the 10-year anniversary of the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which was signed into law on Oct. 3, 2008. It is a momentous law, promising an end to discriminatory coverage of mental health treatment thus providing hope to millions of people who struggle to access appropriate mental health treatment.
Prior to passage of parity many people had higher co-payments for mental health treatment, limits on the number of therapy visits that were not based on need, limited drug formularies and other barriers to care such as limited networks, lack of coverage for new treatment or even basic treatment. Families went into debt in order to ensure a loved one was able to access much needed treatment. The parity law tried to address these issues.
Parity seeks to treat mental health care the same as other health care conditions in three areas: out-of-pocket costs, arbitrary treatment limits and what is called non-quantitative treatment limits – using similar processes for determining medical necessity, use of provider networks, fail first policies, etc.
During Mental Illness Awareness Week we typically focus on public attitudes – seeking to eliminate negative stereotypes and promote acceptance – but not this year. After ten years we have yet to realize the promise of mental health parity.
Families continue to struggle especially with non-quantitative treatment limits. Rehab is often covered on the health care side – but not the mental health side. In-home treatment for seriously ill children is covered – but not if the serious illness is a mental illness. Networks of providers are often more limited for mental health, and new mental health treatments – even when approved by the FDA – are not covered.
Changing attitudes is important, ending discrimination even more so.
Most people don’t know whom to call when they find their health insurance plan won’t cover needed mental health treatment or can’t find a provider in their network. It’s complicated since it depends on what type of plan it is. The Minnesota Department of Commerce has a “no-wrong-door” policy so people are encouraged to call them at 651-539-1600.
But people shouldn’t have to file a complaint to enforce parity. Parity should be enforced upfront by the Departments of Health and Commerce. Legislation to enforce the parity law in Minnesota was introduced in 2017 and had hearings in 2018.
Unfortunately, it didn’t pass.
The Kennedy-Satcher Center for Mental Health Equity recently found that Minnesota’s statutes on parity received 51 out of 100 points, thus receiving an “F” grade. The states with the highest grades on how their statutes implement parity included Illinois, Tennessee, Maine, Alabama, Virginia and New Hampshire. The report can be found at ParityTrack.org.
We cannot build our mental health system if private health insurance continues to treat mental illnesses differently. It’s time to focus on parity as a human rights issue and ensure access to appropriate treatment. During this year’s Mental Illness Awareness Week, let’s all become more aware of mental health parity and lack of enforcement and let candidates and current Senators know that this needs to change during the 2019 session.

Sue Abderholden is the executive director of NAMI Minnesota (National Alliance on Mental Illness), a non-profit organization working to improve the lives of children and adults with mental illnesses and their families.