Mental Health Parity

Probably the biggest, most bitter irony of my sister’s death is that she overdosed on her anti-depressant, the very thing that was supposed to help make her better. This isn’t something I’ve spent an awful lot of time dwelling on, instead it’s just another in the long list of sad circumstances surrounding her suicide. This week, however, I have been thinking about it, especially after I received an email requesting my help in raising awareness about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and the fact that since 2010 final implementation of the law has been stalled under the Obama Administration.  

First, some background.  Senator Paul Wellstone was a champion of legislation that would end discrimination against people suffering from mental illness.  After his death, the above-mentioned legislation was introduced by a bipartisan group of Senators and Representatives. The law was passed by Congress in 2008 and signed by President George W. Bush.  It requires large group and Medicaid-managed health plans that include mental health and substance abuse benefits along with standard medical and surgical coverage to treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.     

Although as a Senator President Obama voted for the law, and from all indications remains supportive of it, final implementation of the law has been stalled under his administration since 2010.  As a result, there is confusion among employers over what has to be covered, with many employers still not offering mental health benefits as part of their group plans.  Some that do offer mental health benefits impose barriers and limitations to the coverage that don’t exist for physical conditions.  The failure of the administration to act and issue the final rule on the law that would make it a reality means that every day people suffering from mental illness and substance abuse are being denied coverage for their conditions, or having unfair, discriminatory limitations and restrictions placed on the coverage that is offered.

What does this mean?  It means those suffering from serious, often debilitating and potentially life-threatening mental illness and substance abuse issues are often unable to receive the treatment they need.  I have to wonder if things could have turned out differently for my sister if this law had been in place.  Instead of feeling hopeless and overdosing in order to achieve her final escape, she could have received life-saving treatment.

The last year of her life was difficult one.  Her 15+ year fight with bipolar illness had taken a toll on her spirit and her will to live.  She was very sick and she knew it, although she didn’t often openly admit it.  There were times, though, when she would open up to me about her struggles.  She knew she was drinking too much and hinted at it being enough of a problem that she didn’t think she could overcome it alone.  She was also very thin, not eating, anemic, although for some reason I never directly confronted her about her obvious eating disorder, which always manifested when she was having an especially fierce battle with her inner demons.  Since she lived alone it was hard to know exactly how sick she really was, but I suspected she spent far too much time alone, self-medicating with alcohol, not eating, willfully missing doses of her anti-depressant.  Whenever she’d call me especially distraught and overwhelmed, one of the first questions I always asked was “Have you been taking your meds?”  Frustratingly, maddeningly, she’d often take them until she felt better and then stop taking them regularly, further contributing to her highs and lows. 

She talked about going somewhere for intensive, in-house therapy and rehab for several weeks.  She knew she was spiraling out of control and that she couldn’t stop the downward spiral alone.  She also knew how expensive such treatment would be.  She’d done the research. She couldn’t possibly afford it and didn’t dare come out and directly ask our parents for help paying for treatment.  She didn’t have any assets to speak of that she could borrow against and was already stressed financially.  Besides, there was her job to consider, and she worried about what reason she’d give to her employer for needing such an extended absence- about how it would affect her job security. 

Instead, she agreed to start seeing a therapist again.  Even paying for those visits was burdensome for her.  I remember looking through her checkbook after her death, seeing copies of checks she’d written for therapy, realizing what even that minimal amount of treatment had cost her out-of-pocket.  She needed so much more.  Cost shouldn’t have been the deciding factor, but it was for her, as it is for so many.  Part of me understands the utter defeat she must have felt, the overwhelming burden of how sick she was, knowing what it would really take for her to get better and feeling that it was out of reach. 

A National Survey on Drug Use and Health published last year showed that of the 45.9 million adults with mental illness, fewer than half receive counseling or treatment.   Receiving and paying for treatment of mental illness and/or substance abuse should be no different than receiving treatment for physical illnesses. Treatment outcomes for those with serious mental illness are comparable to outcomes to general medical or surgical treatments for chronic medical conditions.  In fact, treatment outcomes for common surgical treatments like heart disease have an approximate 40 to 60 percent success rate.  Success rates for early treatment of mental illness are 60 to 80 percent (Health care reform for Americans with severe mental illnesses. Report of the National Advisory Mental Health Council. American Journal of Psychiatry 1993; 150:1447-1465).

It’s too late for my sister to get the help she needed.  It isn’t too late for the millions of others who are struggling with mental illness and substance abuse.  So far, I haven’t been political in my blog posts, but this cause is much too personal for me to not raise awareness.  Every day for the rest of my life I’ll live with the devastating result of a life lost to suicide because of untreated mental illness.  I don’t want anyone else to have to face the same consequence.

May is Mental Health Awareness Month.  If you care about mental health parity, I urge you to please contact the President and ask him to issue the final regulations for the Mental Health Parity Law.  You can email the White House by following this link http://www.whitehouse.gov/contact/submit-questions-and-comments.  Under subject select “Health Care” under “I Have a Policy Comment”.  You can also call the White House Monday-Friday, 9 a.m. - 5 p.m. and leave a voice mail message at this number 202-456-1111.

Thank you.