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 campaign at<www.equitycampaign.net>.

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 1).

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 health parity."

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 said.

In addition, small groups and self-insured groups are not subject to the parity provisions.

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 health issues.

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 meaningful bill."

More information about the Mental Health America survey is posted at<www.mentalhealthamerica.net>.▪