Parity and Public Safety
Right after participating in a press briefing with former Congressman Patrick Kennedy, Jeffrey Lieberman, MD, President of the American Psychiatric Association, and Senator Richard Blumenthal on the final parity rule issued today by the Obama Administration I received this email:
“What a final rule blessing. I have been an advocate for so many years, testifying and pleading for us to be heard — ever since I lost my son to addiction. When I lost my son to addiction, I called the office of Paul Wellstone and that was in l998. Parity without coverage for substance abuse treatment is not parity.”
I couldn’t have said it better than this mother did.
The final rule comes shortly before the first anniversary of Sandy Hook, a tragedy that advanced the national dialogue on mental illness as never before. So it’s natural that parity news coverage focuses on the implications for people with serious mental illness and public safety. The New York Times reports, “In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders.”
The implications of parity for people with serious mental illness are indeed significant. In the case of Sandy Hook — as in Aurora, Tucson, Virginia Tech — the perpetrators were individuals with serious mental illness who were not in treatment. With parity, people with mental illnesses, with the help of their families and communities, are more likely to get treatment because it’s now covered by their insurance. But while tragedies of this magnitude warrant our outrage and our grief and seem to occur with chilling frequency, they are rare.
Rare in comparison to another public safety threat that is far more frequent and widespread — the threat to safety that emerges from untreated substance use disorders. Our jails and prisons are filled with men, women, and youth whose crimes directly relate to untreated substance use — untreated all too often because we continue to view these disorders as moral failings rather than chronic medical conditions.
Up to 75% of those who begin addiction treatment say they’ve engaged in violent behavior — physically assaulting, mugging, and attacking others with a weapon. A national report revealed that 85% of America’s prison inmates could benefit from alcohol and drug treatment. In fact, 458,000 million inmates were under the influence of alcohol or other drugs at the time of their crime, committed their offense to get money to buy drugs, or were incarcerated for an alcohol or drug law violation. But most often those with substance use disorders are victims – since 1980 600,000 Americans have died of AIDS while 3.3 million have died of substance use.
Parity rights the wrong of untreated substance use disorders, requiring coverage of substance use treatment equal to coverage for physical conditions and mental illnesses. The final rule makes it clear that if the insurer pays for post acute care for physical conditions then they must do so for substance use disorders – intensive outpatient and residential treatment join an array of rehabilitation services long viewed as legitimate.
If every family understands the signs and symptoms of substance use and mental disorders and knows where to get help, we take a step toward becoming a healthier and safer nation. Mental Health First Aid, highlighted in the wake of Sandy Hook, is an evidence-based vehicle for delivering that education, but the parity rule — establishing equality of treatment — is our touchstone. We are grateful for the law and for an administration that thoughtfully fleshed out regulations in the exceedingly complex arena of healthcare.
Effective implementation of parity will require all of us to work together — the heartbroken mom that reached out to me, insurance companies, providers and patients — each of us doing our job to do what Congressman Kennedy intended, delivering quality treatment to those who desperately need help.