Mental health parity — treating mental and physical illnesses with equal seriousness, concern, and coverage — has been the law of the land for decades. But changing laws is easy; changing actual clinical practice and the health care system that supports it is far more difficult.
This week the Massachusetts Senate is scheduled to vote on a package of legislation aimed at bringing actual practice into the 21st century. The Mental Health ABC Act: Addressing Barriers to Care seeks both to “erase the stigma of mental illness” and “build an affordable integrated system,” Senate President Karen Spilka said in introducing the legislation last Thursday.
Spilka has often talked about growing up in a family where her father’s mental illness — today it would probably have been diagnosed as PTSD as a result of his service during World War II — dominated the family’s life.
“My father never sought help,” she said, “because according to him it wasn’t him, it was everybody else.
“For me, this bill has been decades in the making,” she added.
The legislation attempts to address the parity issue by mandating coverage and eliminating prior authorization by insurers for adults and children seeking treatment for acute mental health crises. It would also require an “equitable rate floor” for “evaluation and management services that is consistent with primary care” and would require quicker resolution of parity complaints by consumers.
The bill calls for an examination of the role of behavioral health managers — to which many insurers contract out mental health coverage, thus adding a layer of confusion for patients and a division of responsibilities that makes the already difficult job of securing benefits even more difficult.
Other aspects of the legislation seek to address the very real problem of access. One would require any hospital with an emergency department to “have the capacity to evaluate and stabilize a person admitted with a mental health presentation at all times.” It’s almost astonishing to think some hospitals don’t have a psychiatrist on call, but that can indeed be the case.
“Our system is broken,” said Senator Cindy Friedman, cochair of the Joint Committee on Health Care Financing. “Mental health has long been treated as the stepchild of the health care system.”
But breaking that pattern won’t be easy. Friedman cites the problem of children with acute mental illness who may be “boarded” in an emergency room for weeks. But that problem won’t be solved by having a psychiatrist on call or an insurance company that won’t balk at paying the bill without prior authorization.
Often it can be solved only by finding an available and appropriate in-patient bed or an available clinician who can come up with a long-term treatment plan.
In terms of increasing those scarce beds, Governor Charlie Baker’s more wide-ranging bill to encourage a shift in spending by providers to primary and mental health care (by 30 percent over three years) offers a possible solution.
But both bills share a number of good provisions for increasing the available pool of mental health clinicians (only half of whom accept health insurance of any kind), including one simply to make all health insurers use the same reimbursement form. How difficult is that?
The Senate Mental Health ABC Act and Baker’s broader approach both attempt to offer realistic solutions to pieces of our exceedingly complex mental health care system. They’re not mutually exclusive.
Spilka said she opted for a separate mental health package “because we were able to do a much deeper dive” into access issues but added that she has worked closely with Health and Human Service Secretary Marylou Sudders, who was, after all, a former commissioner of mental health.
Massachusetts Association of Health Plans president Lora Pellegrini was largely supportive of the Senate effort, especially the notion of a special commission that would bring all stakeholders to the table to try to come up with a “common set of medical necessity criteria” for mental health services. “This would move the system forward,” she said.
It is long past time to do that.
Beacon Hill has a July 31 deadline (the end of this year’s session) to get this important legislation passed. The Commonwealth’s residents in need of mental health care and their families shouldn’t have to wait any longer than that.
Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.