Is Mental Health Parity a Civil Rights Issue?

While in DC last week, I heard someone quip: “Mental health parity was and continues to be a civil rights concern.” Frankly, while I had always thought of it in terms of equity and fairness as well as a resolution of stigma and discrimination issues, I had not thought often of Parity in terms of civil rights. I’m happy to do so. Anyone who has ever had to deal with mental health and substance abuse issues in their home, among family, friends or in their workplace knows that real people and real lives are on the line. This is not an insurance problem and it is not an issue of co-pays and deductibles. It is a fact that people who have suffered from heart disease or cancer are treated one way and people who suffer from disorders of the brain are treated another way.

The new Federal Parity Act will address many of those concerns but it by no means solves the problem. Upcoming changes in coverage still leave a great many people – sufferers and family members – out of equitable and fair coverage. Until regulations are issued by the Federal government, the jury is still out on how well the Mental Health Parity and Addiction Equity Act of 2008 will provide truly fair and equitable coverage for those who are eligible for coverage. It could well be that only those who suffer from the “right” diagnosis will be covered. It could be that only some levels of evidence-based treatment are covered while others are not. Health care providers may not be able to refer their patients to the most appropriate services and specialists. Many unanswered questions remain and many of those questions are troubling.

What to do?

Whether you’re a policy-maker, payer, provider or consumer, it’s important to keep the following concepts in mind as you act on behalf of equitable access to coverage and treatment of mental health and substance use disorders:

1. our health care system is flawed and is in need of reform and transformation. That means painful CHANGE for everyone
2. we all have very limited financial resources to work with. Yes, that means rationing. That’s the very definition of rationing
3. we have to establish shared standards for rights (parity, equity and fairness), quality, efficiency, and access to care
4. we have to implement those standards by law, regulations, policy and procedural means
5. we have to communicate, educate and train
6. we have to measure our collective performance against our standards and hold each other accountable when we fall short of excellence
7. we have to be part of the solution and that means becoming very ACTIVE agents of CHANGE

Olmstead – More on Civil Rights

The 1999 Olmstead decision stipulated that under the Americans with Disabilities Act (ADA), people with disabilities are eligible for public services in the most integrated settings possible. The intention of the Court was to give people the opportunity to live independently as opposed being segregated in institutional settings.

The Bazelon Center for Mental Health Law released a report celebrating the 10th anniversary of the Olmstead Act this week. Their recommendations include:

• “States must determine how many people with disabilities are served in unnecessarily segregated settings and what community-based services are necessary to support reintegration and recovery. They then must shift funding from institutions to community-based services.
• Implementing Olmstead programs through health care reform would save billions of taxpayer dollars by making essential community services available to people with mental illnesses.

• Often pressured by profit-making providers, states continue to waste valuable resources by placing people with mental illnesses in costly, ineffective institutional settings. The cost of a supportive apartment is one eighth that of state hospital care, just over a third of the cost in a board-and-care facility.
• It is critical to promote Supreme Court and other judicial nominees who have an understanding of and intention to uphold Olmstead, the ADA and other civil rights laws.

“On this pivotal anniversary of Olmstead, we must take a hard look at what really needs to be accomplished to adequately serve millions of people with mental illnesses so that they receive the most integrated care possible. We are encouraged by President Obama’s statement of commitment on Monday to Olmstead‘s civil rights and community integration mandates, and we hope that the release of this report spurs additional action,” said Robert Bernstein, Ph.D., executive director of the Bazelon Center for Mental Health Law.

Bernstein, executive director of the Bazelon Center, highlighted the Olmstead 10th Anniversary call to action, detailing specific steps that Congress, federal agencies and the states should take to create community-based care models. He also described how Olmstead programs can guide healthcare reform and save billions of taxpayer dollars.

“We have only seen progress toward implementing Olmstead principles in the past decade through litigation. It is time for states to follow the integration mandate given by the ADA and reinforced by the Supreme Court. They must work to ensure that robust mental health services and supports are available for people with psychiatric disabilities who wish to return to a normal role in their communities after being segregated in institutions,” said Ira Burnim, legal director of the Bazelon Center for Mental Health Law.