Equality for mental illness

Our view: New rules should help more Americans gain better access to mental health care and addiction treatment

November 11, 2013

Ask anyone who has been diagnosed with a mental illness or addiction or sought treatment for a family member or friend with such a condition, getting proper medical care can be a huge challenge. Bad enough that those with an illness may themselves resist treatment, but getting health insurance companies to pay for it can be exceedingly difficult in a world of pre-authorizations, caps on benefits, in-network requirements and other maddening restrictions.

That's why last week's publication of final rules implementing a 2008 law guaranteeing parity — that mental health care will be treated by insurers as equivalent to other medical treatments — is so groundbreaking and important. No longer must someone with bipolar disorder, to name one common diagnosis, be denied coverage (or forced to jump more administrative hurdles) than someone with a broken leg or a heart attack.

For many Americans, these regulatory reforms may already have been in evidence, as most major plans have already adopted them based on earlier rule-makings. The implementation of the Affordable Care Act means millions more people will soon have the benefit of mental health and substance abuse insurance coverage.

While some critics may complain that expanded coverage will raise premiums, such criticism ignores the reality of mental illness. The earlier treatment is made available to people, the less costly their illnesses are likely to be to themselves and to society; helping patients stay in jobs and keep families intact while they enroll in outpatient programs and other treatment options is far less costly than an emergency hospitalization.

According to the National Institute of Mental Health, about 1 in 4 Americans age 18 and older have a diagnosable mental disorder. Obama administration officials estimate that the parity rules will thus make treatment more affordable and accessible to about 62 million Americans.

These changes have been long-awaited in the psychiatric field. For many, the journey from an act of Congress (the Mental Health Parity and Addiction Act was signed into law by George W. Bush) to regulations has been frustratingly long. That chronic depression doesn't show up on an x-ray doesn't make the illness any less real — or the need for prompt, effective treatment any less pressing than other types of injury.

Some of the recent mass shootings might have been prevented if their perpetrators had been diagnosed and treated for their apparent disorders. Indeed, administration officials pointed to the parity law as one of the more important measures implemented post-Sandy Hook to prevent such episodes from happening again.

That's not to suggest that the parity rules are by themselves a cure for all mental disorders. They do not apply, for instance, to Medicaid, which often provides health coverage for adults with more serious illnesses such as schizophrenia who are often unable to hold jobs. That lack of quality care for the poor and disenfranchised has long proven costly — particularly for prisons when such individuals run afoul of the criminal justice system.

Nor are the rules so comprehensive that insurance companies won't likely find other ways to discourage what they deem as over-utilization. Enforcing the new rules is likely to prove a challenge for state insurance commissioners who are busy these days with Obamacare and its health care mandates. And insurance plans that limit medical treatment, in general, will certainly be able to limit mental health treatment to an equivalent degree.

Still, this is an important milestone. Catching mental illnesses early may be a little bit more costly in the short-term, but it could yield considerable savings in the long-term if it means health crises are averted. That's good for the individual, for families and for employers. It's not to hard to imagine, for example, how treating a drug addiction early could prevent an untreated addiction's more horrific consequences for all involved.

It's also fundamentally a matter of civil rights and compassion. Those with an illness of the brain deserve the opportunity for decent, affordable medical treatment as much as those with disorders that affect the body. That insurance plans must provide that coverage on an equivalent basis may also lessen the stigma associated with mental illness — and the isolation that so often comes with it.

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