Advocating for Mental Health Care - a health parity issue opinion

An opinion column jointly authored by Mrs. Carter and Patrick Kennedy, two important advocates for Mental Health care.  Although Republicans talk about mental health, they and their insurance company lobbyists do very little to support access to quality and affordable mental health care.  

Thank you to President Jimmy Carter and to Mrs. Rosalynn Carter for your humanitarian careers. This opinion about Mental Health care is another example of how Mrs. Carter continues to advocate for people who are suffering from mental illness. By the way, I still regard Mrs. Carter's book "First Lady From Plains" to be the best #1 "First Lady books".

This echo opinion was published in the The Washington Post and other newspapers: 

Patrick Kennedy is the author of “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.” 

Almost 10 years have passed since Congress required that insurers offering mental-health services for illnesses of the brain, such as depression or addiction, do so no more restrictively than illnesses of the body, such as diabetes or cancer. And yet, most insurers today still do not comply with the law.

Mental-health parity is more important now than ever before, considering the rising numbers of overdoses and suicides nationwide. But state and federal investigations have shown that mental-health and addiction treatment are frequently far more onerous to manage.

This has become an issue of human rights. Too often, people seeking these treatments are denied coverage or don’t receive enough treatment because of insurers’ overly aggressive managed-care techniques and subsequently die from overdoses or suicides. In other cases, families — desperate to keep their loved ones alive — take out second mortgages, deplete retirement accounts and drain college funds to pay for treatment services their plans won’t cover.

To disrupt this vicious cycle, we must confront the reality that our current system of insurance-based health care oppresses those with mental-health and substance-use disorders.

Violations of mental-health parity laws can take many forms. Insurance companies frequently limit how long and how often patients can receive care through rigorous pre-authorization requirements. Patients also face narrow networks of mental-health providers; complicated drug formularies that limit prescription coverage; and requirements to try less expensive treatments before pursuing the most evidence-based treatment recommended by their doctor.

The ordinary consumer has no idea what to do when coverage is denied. Most don’t even know when a parity violation has occurred. That’s because health-insurance companies rarely provide specific information regarding details of a denial, which makes it difficult for consumers to file an appeal and alert regulators. In other cases, “medical necessity” review criteria are disclosed but incorrectly applied. As a result, confused patients and their providers are unable to challenge denials in a meaningful way — unaware of the resources available for help.

In no other health-care situation would this be acceptable. People with mental-health and addiction challenges deserve equal access to care. We must bring transparency to a system that counts on silence and confusion to save money.

The problem starts with the complexity of the law itself and the way our insurance system works. It took many years for the federal government to develop regulations to implement mental-health parity as mandated by Congress, and there are still gray areas on which many in the health-care industry disagree. These lack of guidelines and inconsistencies in compliance programs have contributed to poor enforcement efforts.

But there is hope. Federal and state regulators continue to issue more regulatory guidance, and representatives from the insurance industry, health-care providers and consumers are helping to develop the first set of comprehensive mental-health parity accreditation standards to be released this fall. Meanwhile, states such as Colorado, Delaware, Illinois, Tennessee and Rhode Island are developing their own solutions to increase access to mental-health and addiction treatment.

Some people decry the cost to achieve mental-health parity. But, ironically, neglecting to enforce the law is actually costing the federal and state governments billions of dollars. Patients who are depleted of resources often turn to Medicaid or other government-funded programs for assistance with treatment. Lack of coverage also leads to more people being incarcerated, which carries an exorbitant price tag for taxpayers. The Centers for Disease Control and Prevention estimate that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment and criminal-justice involvement.

And yes, while any insurance mandate is likely to increase insurance premiums in the short term, we must consider the bigger picture. Costs for mental-health and substance-use disorder treatment are much higher once a condition or disease worsens. The ability to proactively address mental health and addiction — along with any other health condition — would help to alleviate this and improve clinical outcomes. We should also prioritize evidence-based treatments and technology to minimize costs.

It is easy to forget, amid the complexities of our health-care system, that real human lives are at stake here. Parents should not have to face financial ruin to save their children’s lives, especially after paying into an insurance plan for years. Sadly, this is happening across the nation.

Attitudes toward mental health and addiction are finally changing. Stigma and discrimination are no longer acceptable. Our system must catch up.

Rosalynn Carter, former first lady of the United States, is an advocate for mental-health care through the Carter Center. Patrick J. Kennedy, former U.S. representative, D-R.I., from 1995 to 2011, is the founder of the Kennedy Forum and an author on mental illness and addiction.

President Obama Focus on Mental Health Care

Mental Health care and Mental Illness, in the past, has been the high profile focus of First Spouses.  

Perhaps, as a result of the relationship between gun violence and mental illness, President Obama is now speaking about how to support people who are seeking mental health treatment.

The massacre at the elementary school in Newtown, Connecticut, on December 14, raised awareness about mental health issues. Although little is known about the state of mind of the shooter, 20-year-old Adam Lanza, who committed suicide, he was reported to have exhibited atypical social character traits.
Mental illness and treatment has received executive level attention from past first spouses:

Rosalynn Carter leads a foundation to support journalists who report about mental health care.

"Informed journalists can have a significant impact on public understanding of mental health issues as they shape debate and trends with the words and pictures they convey. They influence their peers and stimulate discussion among the general public, and an informed public can reduce stigma and discrimination." – Former First Lady Rosalynn Carter

Barbara Bush revealed her experience with emotional depression.

Barbara Bush was overcome by severe depression, but says she beat it in six months by losing herself in volunteer work, and it has never returned. "I would feel like crying a lot and I really painfully hurt," the first lady is quoted as saying .  "And I would think bad thoughts. . . . It was not nice." She added that the sickness came after a two-year stint in China by George Bush as U.S. liaison officer in Bejing, where the couple was together most of the time. That changed when he became CIA director back here. Bush said she went to work at Washington House, a center for the seriously ill, where she did jobs like changing bedclothes and washing patients' hair."

Tipper Gore, the wife of Vice-President Al Gore, spoke about mental illness.  "I believe every one of us — at every level of government and in every community — have an obligation to do our part to meet this challenge (to help more Americans with mental illness to reach their full potential)," she said in a 1999 speech at Dartmouth, in New Hampshire.

Nevertheless, prevention and treatment of mental illness continues to be the brunt of budget cuts, in large part due to the stigma associated with people who seek care.  Glenn Close, the actress. has been an outspoken advocate to improve mental health care.  "The truth is, the public perception of the (mental health) stigma has hardly budged," said Close, who has worked to reduce stereotypes.

Mental illness is simply not perceived the same way as other illnesses like cancer or bacterial infections.  

Unfortunately, people at risk for mental illness typically must exhibit symptoms before they reach out for help.  Ideally, those at risk for mental illness should access primary care and prevention before an exacerbation of symptoms, or after they're acutely ill.  

President Barack Obama is now on the record supporting access to mental health care.  He said Americans need to become more open about mental health issues, so that people struggling with problems are not ashamed to seek help.

More than 60 percent of Americans with mental illness do not receive treatment, many of them because they are embarrassed or afraid of being ostracized, Obama said, speaking at a White House conference on mental health.

"We wouldn't accept it if only 40 percent of Americans with cancers got treatment," Obama said. "So why should we accept it when it comes to mental health?"

Obama promised to start a "national conversation" on mental health after the shooting deaths of 20 children and six adults at a Connecticut school last year, although he did not mention the tragedy in his remarks on Monday.

Obviously, with "stupid sequester" budget cuts already forcing layoffs in corporations, where federal funds are a primary source of support, even the President's call for improved access to mental health care may wither for lack of funding.

Perhaps the National Rifle Association (NRA) could help. This organization should support mental health prevention and treatment. After all, it's unfortunately evident that many people die in gun violence caused by people who somehow gain access to guns, while exhibiting untreated mental illness symptoms.  

Moreover, President Obama's call for gun controls hasn't saved any lives. Restrictions on guns have stalled in Congress, foiled by a tough fight from the overly powerful NRA and other groups defending Americans' Second Amendment constitutional right to own guns. 

Treatment for mental illness is as important to preventing gun violence as are weapons regulations. Nonetheless, access to mental health treatment too often occurs after deadly crimes occur.  

Support for gun regulations and mental health care deserve the very same attention.  

Mental illness is common in America. Indeed, as many as one in five children suffer from a disorder, according to the U.S. Center for Disease Control and Prevention.

High profile attention to mental illness has not improved access to care. In fact, as attention to mental health and illness improves, the budget to support these initiatives continue to be flat or cut.  

It's time we close the circle and fix all three stools on the mental health conundrum.  Americans need to perceive mental health like physical illness. Moreover, the US Congress must act humanly to improve gun ownership regulations. so mentally ill people don't have access to deadly weapons.  

Finally, funding for mental health prevention and care must receive insurance parity with all medical care.

President Obama is joining the high profile names who are helping Americans to learn about the essential balance between mental health, mental illness, physical illness and good public health care.

Hopefully, funding the high profile attention is forthcoming as well.