That's what past APA President Steven Sharfstein, M.D., told a
Congressional panel at a public forum on parity for mental illness, including
substance use disorders.
"Other organs of the body—the heart, lungs, kidneys—have
more rights than the brain," Sharfstein said. "The brain needs to
have equal rights."
He spoke in January at a forum at the Montgomery County courthouse in
Rockville, Md., convened by Reps. Patrick Kennedy (D-R.I.) and Jim Ramstad
(R-Minn.) to rally support for legislation extending and expanding the 1996
federal parity law. Also speaking at the public hearing were APA Trustee Roger
Peele, M.D., and past APA President Harold Eist, M.D.
Mental health and substance abuse parity has been an APA legislative
priority for years, and APA has worked closely with Kennedy in the past.
The public forum was the third in a traveling campaign undertaken by
Kennedy and Ramstad to rally public opinion behind passage of a comprehensive
mental health parity bill. At press time, public forums were also being
planned for Los Angeles; North/Central New Jersey; Seattle; San Francisco;
Sacramento; Denver; New Haven, Conn.; Pittsburgh; Atlanta; Columbus, Ohio;
Chicago; Ann Arbor, Mich.; and Louisville, Ky.
The forums have been organized in conjunction with local affiliates of the
National Alliance on Mental Illness and Mental Health America, as well as
district offices of local congressional representatives.
"Our goal is to compile testimony from Americans across the country
in an effort to pass the most responsible and comprehensive federal equity
bill possible," Kennedy said in a statement posted on his Web site at<www.patrickkennedy.house.gov/>."
Americans with these physiological diseases of the brain pay their
premiums like everyone else, and their insurance should be there when they
need it, like it is for everyone else.
"Every family in America has, in some way, come face to face with the
burden of these diseases and the difficulty in getting care," Kennedy
continued. "We pay enormously, as individuals and as a society, the
costs of leaving theses diseases untreated. It's time for action."
APA Director of Government Relations Nicholas Meyers told Psychiatric
News that information about the campaign is posted on the APA Web site at<www.psych.org>
under Advocacy, and that local district branches will be notified when a forum
is expected to be held in their area. More information is available about the
The 1996 federal parity law was just an opening salvo in the battle for
nondiscriminatory coverage of mental illness treatment. It requires only that
group health plans for businesses with 51 or more employees set annual and
lifetime dollar limits for mental health care—excluding substance abuse
treatment—at the same levels as for other types of medical care.
Also, the parity law must be renewed each year. The extension for 2007 was
approved in the Tax Relief and Health Care Act of 2006 (HR 6111).
As psychiatrist and health services researcher Howard Goldman, M.D.,
recently told congressional leadership, the current federal law is deficient
because a plan could comply with the law and still have special restrictions
for mental health" (see page
Sharfstein, who is also CEO of the Sheppard Pratt Health System in
Maryland, spoke to deficiencies in the Maryland state parity law.
"Clearly, many citizens in Maryland have benefited from Maryland's
parity enhancement," he said. "Inas- much as it is not limited to
specifically enumerated biologically based mental illnesses, the advantages of
parity are available to anyone who might seek mental health services,
regardless of the nature of their diagnosis."
However, he said that the "true promise of parity" has been
restricted in a number of ways. With regard to outpatient services, he said
the law's tiered copayment schedule quickly escalates to a 45 percent patient
contribution after the fifth visit—a significant out-of-pocket payment
that is not in line with copayments for other specialty care.
Sharfstein added, "Because of the administrative burden and modest
compensation associated with many third party payer arrangements, significant
numbers of psychiatrists and mental health professionals have exited managed
care panels, eroding the safety net in terms of access and contributing to
greater out-of-pocket expense for consumers, despite the illusion of mental
He added that the gatekeeper function performed by managed care has had a
dampening effect on parity.
"Although there are contractual benefits, the strident position on
utilization, differing interpretations of medical necessity, and cost-driven
expectations about the duration of stays in inpatient and day-hospital
settings have seriously minimized the impact of parity," Sharfstein
In addition, small groups and self-insured groups are not subject to the
Finally, he said that some provisions of the law have been interpreted by
payers in ways that have diminished it, while efforts to enforce regulatory
compliance with the statute have been less than vigorous.
"The intent of the parity law to allow for up to 60 days of coverage
for psychiatric partial hospitalization has been reinterpreted by payers in a
way that has been highly unfavorable to patients and has diluted their access
to outpatient benefits," he said. "Similarly, the clearly
expressed requirement in the law that medication-management visits for mental
health should not [diminish] the mental health benefit for purposes of
copayment determination has been sorely abused."
Several signs point to the possibility that a comprehensive parity law will
finally be passed at the federal level. According to a survey by Mental Health
America (formerly known as the National Mental Health Association), 89 percent
of Americans—including Democrats, Republicans, managers, and
employees—favor legislation to end discriminatory insurance coverage of
mental illness. Further, 74 percent believe that insurance plans should cover
treatment for substance abuse at the same levels as for treatment for general
The "Mental Health America Attitudinal Survey" was conducted by
International Communications Research, an independent research company.
Interviews were conducted via telephone and the Internet from October 10,
2006, to November 1, 2006, among a nationally representative sample of 3,040
respondents aged 18 and older.
At the January rally in Maryland, Sharfstein said more than 200 members of
the public turned out, many of whom were carrying signs and placards in
support of parity.
"It was very encouraging," he told Psychiatric News."
I am guardedly optimistic that something will happen this year that
will be an improvement over the 1996 law. We need people to rally around a
More information about the Mental Health America survey is posted at<www.mentalhealthamerica.net>.▪