Parity for Mental Health: Benefits and Dangers

By:   Karen Shore Ph.D, President of the National Coalition of Mental Health Care Professionals and Consumers


Parity in annual and lifetime limits was passed by Congress in the Fall of 1996. Federal and State legislatures are now considering, or may have already passed, "full parity," which includes parity in deductibles and co-payments.

Benefits

Parity allows the possibility that patients with serious mental illnesses (SMI) and those with less devastating but still painful and difficult emotional problems will be able to access appropriate and sufficient treatment that will allow them to achieve and/or maintain their highest level of functioning. This would benefit patients, families, schools, employers, communities, and the nation.

Dangers

All predictions are that "full parity" will lead most employers and health plans to "manage" the benefits in order to contain costs. The chief problems with the "management" of mental health care are:

1. Under-treatment: Managed care (MC) typically allows only crisis intervention and stabilization or attention to only the most obvious symptoms. It often does not allow mental health patients to fully recover and/or maintain their highest level of functioning. This would not change with parity legislation.

2. Privacy: "Management" of mental health often includes utilization review (UR) procedures which require that the case reviewer be told more about the patient's problems than just the diagnosis. Some patients (e.g., survivors of sexual abuse or assault, those with paranoid conditions, people with sensitive jobs, adolescents, people with any highly personal issue, etc.) cannot tolerate these UR procedures, for they disturb the sense of privacy and safety needed for successful mental health treatment. Many such patients decline their benefits, preferring to "self-pay" for mental health care. However, those who cannot afford to "self-pay" often avoid needed treatment rather than submit to UR. An amendment to parity legislation is needed to make sure these patients can obtain some benefits, making it possible for them to find appropriate, affordable treatment that protects their sense of privacy and safety.

3. Co-payments have been the only way, other than "management" of care, that costs have been successfully contained. Legislating "full parity" will leave only management of care to control costs.

We must guarantee that all mental health patients can access affordable, appropriate care. An alternative is needed to protect consumers who could be harmed by "managed parity."

Solution

Amendment to parity bills and laws: Mandate that all plans offering a "managed" mental health parity benefit also offer enrollees the option of declining the parity benefit and choosing, instead, a non-managed non-parity mental health benefit in which the co-payment or deductible may be higher than for medical care, or an annual limit may be imposed.

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