IF IT PAYS FOR FORCE, IT ISN'T
Vicki Fox Wieselthier
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 anyone's 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 in the summer of 1998 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. In a 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 the parity legislation. This is particularly worrisome when young children are medicalized and given labels that they will carry with them for therest of their lives.
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.
It's 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 rackets 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 month's 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. Don't 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 can't 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.