POSITION ON PARITY FOR HEALTH CARE California Network of Mental Health Clients February 1998
One of the organizing purposes of the California Network of Mental health Clients (the Network) was to eliminate prejudice and discrimination against mental health clients. The Network supports ending legal and civil discrimination of persons with mental disabilities in all areas of life - education, employment, housing and health care. Clearly then, the Network is for parity in health care coverage, providing persons with mental disabilities the same level of insurance coverage as persons with other health problems (although there is a mixture of opinion among Network members as to the existence of a physiological base for mental and emotional problems in living.)
However, the Network is against any health care parity legislation that includes coverage for involuntary treatment. Involuntary treatment should be excluded from coverage in any health care parity legislation.
The intent of promoting health care parity is to enhance anti-discrimination; however, involuntary treatment in health care coverage for persons with psychiatric disabilities enhances discrimination. Legislation including involuntary treatment perpetuates discrimination by treating one group of persons differently than all other groups of persons for whom health care is by choice and voluntary. It perpetuates a double standard, reinforcing all the prejudicial views of mental health clients, from childlike to incompetent. Rather than being, as it has been called, the campaign to end discrimination, it will be a campaign that defends and, in fact, increases, discrimination.
Involuntary treatment in itself is a violation of personhood, intrusion without consent upon a persons body and mind. It is so repugnant to human understanding that medical interventions, with the exception of psychiatric, are soundly based on choice, with clear and complete consent policies. The idea of requiring payment for the violation of ones own civil rights, is cruel. The Network did a survey several years ago in which 53% of the clients interviewed reported that the fear of forced treatment caused them to avoid all treatment for psychological or emotional problems. Clearly, the experience of involuntary treatment is traumatic.
To many, including the California Network of Mental Health Clients, involuntary treatment is an ineffective and harmful way of helping people. To others, who believe it is at times necessary, it is seen as a last resort and the least effective way of helping persons in distress. Yet, all indications are that health care parity that includes involuntary treatment will increase its use.
If private insurance companies cover involuntary treatment, more people, who otherwise would be released and/or enrolled in community services, will be involuntarily detained. Private hospitals, as is their history, will hold involuntary detainees until their insurance monies run out. Monies that could have been used for community services will have been spent. If monies were available for only voluntary services, there would be more incentive to develop effective, client driven community services instead of continuing the traditional, least effective hospital-based interventions. Parity that includes involuntary hospitalization defies the trend of the mental health system for the last 25 years which is for services in the community. It would increase the worst of mental health treatment and decrease the best.
Clients have discussed this issue in many different venues, nationwide and statewide. The clear consensus is that clients want monies to be available for use in community alternatives and not for involuntary treatment, which is seen as both immoral and harmful and, by definition, against our will.