Mental Health Parity

Mind - Body Politics - NYT article
Check out the above article for the truth of the matter.

In the state of California, there has been the law of parity between medical and behavioral health care since about 2003 or 2004 - I can't remember. There are other versions in most states, and this month, the issue has been brought to a federal level. Basically, it means that behavioral issues should be parity to medical issues - insurance companies are no longer able to put a cap to psychiatry & psychotherapy treatment the same way they can't to a medical problem such as diabetes or cancer.

The question that underlies Mental Health Parity Act is "Is there a mind body connection?" Well, puhlease! I think we all know that there is. Do you get a headache when you're anxious? Does your pulse race when you're upset? But yet it has to again and again be demonstrated scientifically. Too bad for insurance companies, because there's now a lot of data to prove the point.

When parity first came out in CA, I was working at an insurance company as a case manager. There was a huge panic about it, if we couldn't capitate people's benefits, how could we control the utilization of care. Would everyone want to be in long term therapy? Well, the answer to behavioral health parity, as with medical insurance, is "medical necessity". One can have a problem, but does it need ongoing or intensive treatment?

Just because someone has a heart problem, it doesn't mean they can electively choose to undergo heart surgery and have the insurance pay for it unless it's medically necessary for their survival. Only it's pretty hard to develop uniformity of treatment protocols when the current measurements of mental health distress cannot be captured by a CAT scan or EEG.

What comes to my mind when I hear "Medically Necessary" is the alternative to what I call "Quality of Life". Meaning, should my medical insurance pay for non-necessary plastic surgery? Can I live without the Double D's? versus, of course the chemotherapy is needed to save my life. Other scenario - Can I function normally (holding a job, maintaining safety and self care) without psychoanalysis of my Oedipus complex or am I about to go hurt myself or someone else because of it?

I worked at the insurance company while my kids were young. It was a perfect fit, I worked from home, I had flexible hours and full benefits. Then it started to get on my nerves. Even being back in the office, I felt like I was going in daily to my own coffin. Who was I helping? Did it even matter? I felt like I was playing a game of monopoly. My productivity was measured on # of calls I took and how much I produced without having an attitude. My clinical skills floated in cyber space.

I learned so much from that job - I did a lot of growing up on that job. I'm glad I'm out of there. Now being back to hospital work, "medical necessity" takes on a fuller meaning. It's easy to distance myself when I'm drinking a cup of coffee at the computer, taking a call from someone I don't know. It's a different ball game to see blood, scars, stitches, icky things (Note: There's a reason I'm not a nurse.) I've seen staples sticking of a self imposed slash to the neck. Hundreds of overdoses. Slit wrists. Attempted electrocution. Near gunshot wounds. Confusion. People who were found by the side of a bridge or cliff, contemplating jumping off. People who've maimed other people due to hearing voices and psychosis.

People don't do these things because they had a bad childhood. Hey, if they did, we'd all be in the shrink ward... There is some kind of brain chemistry that affects judgement and impulsivity that cannot be fully understood by talk therapy. These are medical conditions whether the insurance company wants to admit it or not.

So Kudos to American Government for allowing the issue to present in their courts. It's a step in the right direction.