Pretending we have equal coverage for mental and physical illnesses is a joke
There were two stories in this newspaper over the last couple of days that were more inter-related than they might at first appear.
The first one reported in rich detail how many people with serious mental illness are being released by the chronically underfunded state Department of Mental Health to live in the community without proper supervision — with sometimes disastrous results.
In the other one, people who suffered invisible injuries such as post traumatic stress from the Boston Marathon bombings talked of feeling excluded from the community of survivors.
Together, those stories inform a larger point: Almost a decade after mental health care parity became the law of the land, much of the wider culture simply doesn’t accept it. We remain largely a doubting Thomas society, reluctant to accept the truth of something we can’t see, something we can’t measure with traditional metrics.
Four years ago, Dr. Leonard Rappaport, chief of developmental medicine at Boston Children’s Hospital, told me that the mother of one of his patients, a 7-year-old boy, had to go through a list of 66 mental health professionals to find one to treat her son. Either they weren’t taking new patients, or they wouldn’t accept her insurance.
Lenny Rappaport keeps a copy of that list to remind him that the idea that we have a health care system that treats physical and mental illnesses with parity is a mirage, more aspirational than real.
“If anything, it’s worse now,” Rappaport told me. “The culture doesn’t accept it, and a lot of insurance companies don’t either. There are so many barriers, so many hoops for people to jump through. In what I see every day, it’s a struggle to get kids appropriately diagnosed and appropriately treated if they don’t have resources, if they don’t have money.”
Reimbursement rates for behavioral health therapists remain so low that few take insurance, and many have found it necessary to maintain cash-only practices to survive.
Charles Martel, a licensed independent clinical social worker in Boston who has been a therapist for 40 years, said access has become even more difficult as local mental health clinics have closed in recent years.
“The parity laws themselves remain a very important part of mental health care,” Martel said. “But if you can’t find a therapist who can see you, then those laws don’t make a difference.”
Someone trying to access mental health care is twice as likely to be denied coverage by a private insurer than someone seeking surgical or other medical care, according to a survey of 84 insurance plans in 15 states by the National Alliance on Mental Illness.
Matt Selig, executive director of Health Law Advocates, a Boston-based nonprofit group that represents low-income residents, said that last year alone his agency opened cases for 158 people who were denied coverage for mental health or substance use treatment, nearly half of them children.
Attorney General Maura Healey’s office, which has been pressuring insurers to follow the parity law, found that behavioral health data lags when compared to other areas of care, making it harder to promote parity. Last year, the AG reached a settlement with Tufts Associated Health Plans so they would cover autism spectrum disorder treatments.
Sitting in his office, Rappaport said challenging insurers is important. But he said it’s more than changing the way bean counters at insurance companies see illness. It’s about changing the way the wider culture views it, where many question the legitimacy of illnesses they can’t see or understand and judge those who suffer from them.
“You hear this discriminatory language all the time: addiction is a personal failing; ADHD (attention deficit hyperactivity disorder) is bad kids and bad parenting; people who have mental problems or anxiety or post traumatic stress just need to suck it up. Unfortunately, too many people think like that,” Lenny Rappaport said. “We changed the law. It’s harder to change attitudes.”