Mental health parity and kids — has it helped?

Ten years ago last month, Massachusetts enacted a mental health parity law. As with most legislation, there were a lot of compromises along the way and no one was really sure if this law would make a significant difference. (It was an important moral victory, though.) The list of diagnoses was limited to those that were considered to be“biologically based” (bipolar made it in, post traumatic stress disorder was out) and insurers could impose limits on anything that wasn’t “medically necessary.” PAL was the only organization talking exclusively about what children and families needed and worked hard to get the insurance benefit to pay for therapy in other places than an office. We had high hopes for what the passage of parity would do for children with mental health needs and their families and a lot of hopeful guesses.

Ten years is certainly enough time to tell if any law has made a difference. What parity is supposed to do is simply ensure that your insurance covers your mental health treatment just as it does your medical treatment: same deductible, same authorizations, same copayments. Our parity law of 2000 was limited in scope — many called it partial parity. Does that mean it only partly helped?

Here are five ways that the mental health parity law — with all its flaws — has helped children and youth with mental health needs and their families. Sometimes it has made a direct impact and other times its influence has been more subtle.

First, parity increased outpatient visits so that children have as many visits as they need in a calendar year (here’s where that medical necessity standard comes in: it’s frequently the insurer who decides what they “need”). Before this, children often had only 8 visits (or 12 or 20) a year, no matter what. Many families reported running out of their therapy visits in the summer, often right before school was going to begin. For many, the individual therapy and family therapy visits came out of the same pool so that if you had family therapy, your precious number of individual visits was decreased.

Second, by including children in the language of parity we agreed many kids actually didn’t have perfect childhoods and their mental health needs often look quite different from those of adults. The language in the law for children and teens has standards around functioning, not diagnosis, even though it isn’t always used.

Third, we laid the groundwork for paying for mental health services for kids in different settings. The law said you could receive therapy at home, at school or in other settings. Why is this important? Children and youth often resist going to an office or institution and parents can have a heck of a time getting them there. Many also will speak more freely in a familiar comfortable setting.

Fourth, this law actually did help reduce stigma. When Nancy Collier and I first worked on this law, we had to use our own personal stories to highlight the issue in the media. Now, we have many families willing to speak out and tell their stories, hoping to make things better. Hearing about real people, their struggles and successes, always makes the issue come alive. This willingness to speak out wasn’t there just ten years ago.

Last, this law affirmed to parents and their children that mental health is as important as physical health. We know our children and familes are in every city and town in the Commonwealth, from the child who shows up in the school nurses office with a stomach ache (often anxiety in disguise) to the child who experiences trauma and has witnessed violence in his home or community. Their future depends on all of us saying over and over again, children’s mental health matters to me, does it matter to you?

What do you think? Has mental health parity made a difference for you?

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2 thoughts on “Mental health parity and kids — has it helped?

  1. Well every battle wins something because we are heard. (Your fourth reason). Arguments for parity make sense for people without involvement who might otherwise stick with simple superstitious stigma, like “It’s all an act.” The parity law was improved in 2007 to include PTSD and a few other diagnoses. The insurance companies went to outside adjusters and are still pushing back on authorizations and required paperwork for therapist reimbursements. So in the real world, it’s still and always a fight. But unlike, say, hate crimes laws, there hasn’t been a backlash.
    Rosie D. has set up this weird situation in which a family is better off initially to be poor than have a breadwinner with a job that brings commercial insurance. I am curious to see where Charlie Baker comes down on that. As an insurer, Harvard Pilgrim almost got itself at least one horrific newspaper story last fall in our catchment area. As an incentive economy guy, Baker would have to argue for the private insurers to have a better benefit for child and adolescent mental health, to encourage people to work, really to enable some parents to work. As the prince of privatization, though, he would stand against increasing the cost of insurance rising for employers, although the numbers suggest it could be equalized by spending one dollar per subscriber per year. Fun to ask all the candidates for governor about that kind of parity, actually.

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