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Parity for mental health care rewards the medical system for continuing to provide ineffective or harmful treatment--over
and over again.
In September of 1998, a study of prescribing patterns in Texas was released. The research revealed that psychiatrists
have no idea what specific anti-depressant drugs are likely to be effective in treating any given patient. Parity rewards
doctors who cannot produce successful treatment outcomes by continuing to pay them as they muddle through a long
list of ineffective and possibly harmful drug combinations while their patients are expected to put their lives in abeyance.
Patients that do not get better are blamed and shamed for being uncooperative or difficult. If we finally say "no more" and
refuse treatment, we are labeled non-compliant and then become candidates for involuntary treatment. And while parity pays
for more medication, more visits to the doctor, and unwanted, involuntary medical treatment, it seldom includes benefits for
alternatives to medical treatment.
Parity does nothing to address the long term needs of people who do not respond to drugs and standard
psychiatric care or who choose not to use medical model mental health services at all.
When people reject the medical model of psychiatric treatment they have good reasons for doing so. Some people,
including many family members, would prefer to believe that the "cure" is just a pill or injection away.
Many consumer/survivors have come to realize that drugs and shock therapy do not heal or help if the problems
we face are rooted in childhood experiences or abuse. We know that the barriers we encounter often have more to do with marginalization
and exclusion than illness. Parity increases funding for medical psychiatry and totally ignores the things that we often identify
as our true needs: employment programs; self-help mutual assistance services; complimentary therapies; educational opportunities;
and safe, decent, and affordable housing.
Parity legislation is almost always designed to get insurance
to pay for forced and coercive psychiatric treatment.
When all we have been offered has been drugs, hospitalization, and more drugs, eventually, some of us say, "no,
no more". And we mean it. People with heart disease often disregard physician recommendations regarding diet, exercise, and
stress reduction. They are not told that their lack of insight means that they should no longer have basic civil rights. And
people with diabetes are not given insulin treatment under court order. For these, and every other non-psychiatric medical
condition, insurance pays only for medical treatment that people voluntarily choose. We want parity in rights protection to
accompany parity dollars for medical treatment. That means that private and publicly funded insurance should pay only for
care that the patient consents to and wants. Just as cancer patients are told about a wide range of treatment options and
given information about the risks and benefits of them all, we must have accurate, complete information available to us so
that we can choose the treatment that we feel best meets our needs. Consent must be fully informed and freely given and both
public and private insurance should pay for voluntary treatment only. [See note, below]
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I think we have to be careful when we ask for mental health parity,
let me tell you why...
If a lack of insurance coverage for psychiatric services has resulted in your not being able to access medical
treatment for a mental illness, then the idea of parity may sound pretty good.
Parity is about more money for the medical parts of mental health care. It is about more hospital days, more
dollars for visits to psychiatrists, more money to pay for the newer psychiatric drugs and other medical model services that
are often not covered by insurance policies offered today. It is true that many medical insurance policies have lower limits
for psychiatric medical care, and that this situation is discriminatory. But parity that includes coverage for involuntary
psychiatric treatment is not the solution to discrimination. In fact, when mental health care that is forced or coerced is
part of the parity picture it increases discrimination and subjects consumers and survivors of mental health care to officially
sanctioned violations of our civil rights. Increasing the availability of medical model treatment in the name of parity does
not improve anyones chances of getting other kinds of services. And thousands of people who have been told that they will
be lifetime psychiatric patients have found that with various kinds of non-medical assistance they can lead productive and
fulfilling lives.
Parity often provides huge sums of money to treat people who are diagnosed with specific disorders, and no money
at all for people experiencing distress who do not have those labels.
In California, the parity bill that was proposed both in the summer of 1998 and 1999 would have mandated expanded
medical treatment for six diagnoses, and would have, for all practical purposes, eliminated coverage for anything else related
to mental health. There are immense financial incentives for providers in the parity world. The danger is that everyone who
walks into a psychiatrist's office or is dragged kicking and screaming into a hospital ER will be handed one of the parity
protected labels. There is, after all, no blood test for major depression, x-rays for obsessive compulsive disorder, or definitive
diagnostic procedure for any mental illness. [Regarding this topic, see Dr. Grace Jackson's article {include link} - FFPS]
In parity world, ethical practitioners will have to turn away (or treat for free) people who might benefit from
a variety of medical and non-medical treatments, but do not have one of the "brain diseases" specified within theparity legislation.
This is particularly worrisome when young children are medicalized and given labels that they will carry with them for the
rest of their lives.
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Its not enough to just tell our insurance companies not to pay for involuntary
treatment after they have been sent the bills.
When unethical doctors and for-profit hospitals believe we have the means to pay for involuntary treatment,
they are likely to make sure we get it. In Florida, people came to what they thought was a stress program with bathing suits
and tennis records in hand. When they found that they were going to be admitted to a psychiatric unit and tried to leave they
were committed. The people with two weeks coverage were committed for two weeks. The people with a months worth of coverage
were committed for, you guessed it, a month. There has been at least one successful court case in which the "patient" refused
all treatment while he was forcibly committed and did not have to pay for confinement against his will after the court found
him competent. That said, instructing an insurance carrier not to pay the bill will most likely result in huge personal debt
and probably will not prevent the forced treatment from happening. If you do not want your insurance to pay for your involuntary
treatment, make sure you tell everyone that up-front. Dont sign the insurance forms or anything else relating to financial
liability. Make sure that you endlessly repeat your unwillingness to pay and let them know you will go to court if they attempt
to collect payment from you. It just may keep the provider from admitting you to the hospital or attempting to treat you against
your will.
But, you say, "I benefit greatly from psychiatric medication and medical model treatment; I just cant pay for
it and my insurance won't cover the costs."
If you have found treatment that works then should be able to obtain insurance that covers your treatment of
choice. Tell your story to your legislators; network with other people who want their insurance benefits increased; and complain
to your employer about the coverage that you are offered through your job. Let all of them know that you are entitled to the
best quality care that money can buy because you are worth the investment. Just be sure that you do not condemn other people
to force and coercion by supporting parity schemes that involve coverage for involuntary treatment.
Copyright ©1999 Vicki Fox Smith
Permission to distribute is granted provided it is published in its entirety with this copyright
notice and a link to the MadNation website www.madnation.cc
[Comments and links in brackets added by Friends & Families
of Psychiatric Survivors.]
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