Mental Health Parity for All


Nearly a year later, I still find myself crying when I think of the Newtown, Connecticut, massacre of 20 first graders and their teachers at Sandy Hook Elementary School last Christmas. I didn’t know any of them personally and I don’t live anywhere near Newtown – I live in Atlanta, almost 1,000 miles away. But I am the mother of two stepsons and a 4-year-old little girl who are dearer to me than anything, with another little girl on the way, and I cannot bear to think of the anguish those parents and family members faced that day. Beyond that, I am a human being, and like so many others who heard the news from Newtown from afar, I felt horror and heartbreak on that day last December.

Finally, I am a psychologist in a country where mental illness is still stigmatized, despite the fact that one in four Americans has a diagnosed mental health condition. So when Secretary of Health and Human Services Kathleen Sebelius recently announced the long-awaited final rules and regulations requiring all private American insurance plans to cover mental health treatment on an equal footing with more traditional medical care, I began to feel hopeful. The new regulations for mental health care as an essential service benefit in the Patient Protection and Affordable Care Act of 2010 (ACA) have the potential to significantly improve lives and reduce overall health care costs. Together with the Mental Health Parity and Addiction Equity Act of 2008, these regulations are extending federal parity protections, i.e. equality between mental health care and other types of medical care, to 62 million Americans.

After the Newtown massacre, in which the 20-year-old gunman ended his killing spree via suicide by shooting himself in the head, media reports flew wildly that he had all kinds of diagnoses, from autism to Aspergers to schizophrenia to a personality disorder. These reports were immediately followed by concerned efforts by advocacy groups for these conditions to educate the public, stressing that most of these diagnoses do not carry an increased tendency toward violent acts and should not be blamed for the actions of the Newtown killer.

For the record, I agree with these advocacy groups. Genetic conditions and mental illnesses can’t be generalized – associating them with extreme violence without real evidence can add stigma to already stigmatized conditions, fuelling harmful stereotypes. While a small subset of people with mental illnesses become violent, the vast majority do not.

Yet, there is no doubt that the Newtown gunman was a very troubled young man, in need of mental health treatment. And it is worth noting that after that massacre, along with the movie theater massacre in Aurora, Colorado, a few months earlier resulting in an insanity plea by the shooter, proponents on all sides of the gun-control debate agreed on one thing – the need for improved mental health services.

For the small subset of people with mental health illnesses who do become violent, there is an urgent need for psychiatric treatment, which has not always been easy to come by. One of the many reasons for this has been the disparity between insurance coverage for mental health benefits and other health benefits.

As Dr. Benjamin Druss, director of the new Center for Behavioral Health Policy Studies at Emory University, explains, “historically, mental health and substance use benefits have been covered at a less generous level than for other medical benefits, so for instance, whereas someone who had a hospitalization for diabetes would be covered at 80% for all their expenses, someone who is hospitalized for depression or substance use disorder would be covered at only, say, 50%.”

In 2008, the Mental Health Parity and Addiction Equity Act was signed into law to address this disparity. While the now 5-year-old law was a landmark achievement in its attempt to make mental health treatment more accessible, there was virtually no enforcement of it. It was toothless. Health insurance companies were free to sort-of-kind-of adhere to it, and they often simply chose not to do so. Thus, it was not uncommon for an insurance company to authorize a hospitalization of up to thirty days for someone who had a stroke, but only a two-day hospitalization for someone who had a psychotic break.

The new rules and regulations announced recently, however, combined with the 2008 law, will ensure that mental and physical illnesses are covered similarly. The new regulations are teeth. The regulations are also seen as critical to President Obama’s program for reducing gun violence, because they address the one aspect of the issue on which there is bipartisan agreement: that making treatment for mental health more available may reduce killings, including mass murders like the Newtown massacre.

In her recent announcement at the Carter Center, Kathleen Sebelius stated, “People who either have insurance coverage now and have no mental health coverage or where the Affordable Care Act fills in those gaps for people who have no insurance at all, they will be able to access affordable care with mental and substance abuse benefits.” Furthermore, by enabling more people to have access to care earlier in the onset of mental health difficulties, more costly emergency services and hospitalizations can be avoided later on.

Nearly a year later, parents and families in Newtown, Connecticut, are girding themselves for the anniversary of that terrible day of death, while the rest of us go blithely on with our holiday celebrations and plans. My heart cries out and I want to tell them again how very, very sorry I am for their loss. And I pray that maybe the better access to mental health care provided by the new regulations will help to prevent such a tragedy from occurring again.

Nadia Ali, Ph.D. is a health psychologist on faculty at Emory University’s School of Medicine, in the Department of Human Genetics. She has over 15 years experience providing psychological care with medically ill populations and has travelled throughout the U.S. speaking on topics such as “It’s Not All in Your Head: Dealing with the Psychological Impact of Chronic Disease,” “Collaborative Practice in Hospital Medicine: The Role of Health Psychology” and “Compassion Fatigue: Care for the Caregiver.” She is co-author of a new book, Transitions: Managing Your Own Healthcare: What Every Teen with an LSD Needs to Know, written for teenagers with chronic diseases, as they begin transitioning into the adult world of managing their own healthcare. Dr. Ali is also an Op Ed Project Public Voices Fellow.