The House and Senate passed different versions of the mental health parity bill — the House passed a stand-alone bill, while the Senate version is tucked into a bigger package — and a joint compromise must still be reached before the bill can be sent to the president’s desk.
“We need to get it attached to a vehicle that can get through both chambers,” said Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness.
Howard Goldman, professor of psychiatry at the University of Maryland School of Medicine, called the legislation an important rhetorical step.
“It’s a statement that society values the treatment and doesn’t want to impose unnecessary barriers to getting help,” he said.
For decades, people with mental illnesses have faced higher co-payments and deductibles for psychiatric treatment than for the treatment of other conditions. They have struggled with limitations on the number of doctor visits that health plans will allow, and they have paid more money out-of-pocket for antidepressant or antipsychotic medications than for other prescription drugs.
The mental health parity legislation would require health insurance companies to provide the same level of medical treatment to people with mental illness and substance abuse problems as they would for any other medical condition.
Senators Edward Kennedy, D-Mass., Patrick Kennedy, D-R.I., and Pete Domenici, R-N.M., have been longtime champions of such a bill, as was the late Sen. Paul Wellstone, D-Minn. The bill now has the support of insurance and business groups as well.
Carolyn Robinowitz, past president of the American Psychiatric Association and a practicing psychiatrist, said too many people suffer financial hardship due to insurance limitations on mental health treatment.
“There might be a temptation on the part of the patient or the family of a patient that is worried about medical bills to say, ‘No, we’ll manage. I’ll just go home. I can’t afford it,'” she said. “People sometimes get sent home before it’s in their best interest.'”
But the current legislation would not solve every problem, Goldman said. It would not expand access to care or improve the situation for the 45 million Americans without insurance, he said. It also wouldn’t apply to some more complex treatment interventions, such as team-based services or treatment that involves multiple doctors working together.
Mental illness has a long history of misunderstanding and stigma and was confused in the ancient past with everything from demon possession to a lack of religious faith. Cornelius Celsus, an ancient Roman physician, said it was caused by angry gods and recommended restraint, starvation and whipping as a cure.
Even with the past half century, people argued that mental illnesses were not real and treatment was ineffective and too costly. But a generation ago, we didn’t have the science or the treatments that we have now, Sperling said.
“Through investments in NIH research, we can now make the case that treatment for depression, schizophrenia and bipolar disorder rival, in terms of efficacy, the treatments for cancer or heart disease,” he said. “And we’ve got medical evidence to back that up. We’re not making a discrimination argument; we’re making a scientific argument.”
Goldman added that this should not be seen as special treatment for people with mental illnesses.
“It’s insurance coverage for all of us. You don’t know when you’ll have a panic disorder or find that your child is discovering a mental illness when away at college.”