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Law equalizes treatment for patients with mental illness, substance abuse problems

This article first appeared in the St. Louis Beacon, Jan. 5, 2010 - The New Year brought hope to some people needing treatment for mental-health problems. A federal law that took effect Jan. 1 requires that patients get the same level of medical treatment for mental problems that they now get for other health conditions. But there are some catches. The patient must have health insurance, and the insurance must include coverage for mental health.

In spite of these limitations, advocates are praising the law as an important step toward parity for people seeking treatment for mental problems and substance abuse. Before the law kicked in, even people with good health insurance were accustomed to less comprehensive treatment and services for mental-health problems, such as depression, eating disorders and substance abuse. Advocates say the new federal law moves toward leveling the field for all illnesses.


The legislation is commonly known as the Wellstone mental-health parity bill, a reference to the late Sen. Paul Wellstone, D-Minn. But the official title of the legislation carries a second name, that of former Sen. Pete Domenici, R-N.M. Both men were strong backers of mental-health causes. Wellstone was serving his second term in the Senate when he was killed in a plane crash in 2002. Domenici served six terms in the Senate before announcing in 2008 that he would not seek another term because of health reasons.

Former President George W. Bush signed the bill in October 2008. Though the legislation officially took effect Jan. 1 of this year, health planners have up to a year to redesign their coverage to comply with the law. Local advocates say it may be years before the public experiences the full impact of this legislation.

"This law is important because most health-insurance policies discriminate against people who have mental illness," says Karl Wilson, CEO for Crider Health Center, a community health and mental-health facility in Wentzville. The center serves residents in St. Charles, Warren, Lincoln and Franklin counties. St. Louis County has several facilities to help residents meet mental-health needs, and St. Louis city has two mental-health facilities, as well as four federally funded community-health clinics with some mental-health services.

Although the parity law isn't perfect, Wilson says, it's an important step in dismantling the roadblocks the insured mentally ill typically face in getting comprehensive treatment. Before the new law, Wilson said, employers and insurers could legally impose caps on benefits, require higher deductibles or co-payments and limit the number of times a patient could receive treatment. He contrasted those limitations with the care the insured receive for other illnesses.

"If you are a diabetic, for example, your insurance is not likely to have the same kind of cap that you would have if you went to the hospital because of a mental illness," he says

About 132,000 people in the area have diagnosable mental health problems, says Jacqueline Lukitsch, executive director of the local chapter of the National Alliance on Mental Illness (NAMI). Depression is perhaps the most common problem. But many people go without treatment. Cost is one major drawback to seeking help for depression and other mental illnesses, according to a study by NAMI. Lukitsch says the need for more mental-health services for both insured and uninsured is evident from the 2,000 calls a year made to the local NAMI hotline.

Advocates for the mentally ill say the new law might ease the pressure on public health clinics that now see mental-health patients.

"We're a community health center serving four counties that cover about 530,000 people," Crider says. "We're turning away people for psychiatric care all the time because of the limits on state funds to care for the uninsured."

Because the new law means the insured might rely less on clinics because they will have access to comprehensive treatment in hospitals, Crider says "truly needy people who have no insurance at all may be able to get care quicker" in clinics. But he says the full impact of the law probably won't be felt for years.

Both Crider and Lukitsch point to the law's drawbacks. The biggest concern is that parity still depends on whether insurance benefits include mental health and substance abuse. Lukitsch says companies still have the choice of opting out of providing coverage.

These advocates hope that eventually federal health-care reform will include care for mental health. Both the House and Senate bills include some type of parity requirement, but mental-health advocates say there is no guarantee the final legislation will include blanket parity.

While concerned about the cost of health care, Lukitsch says it's essential that mental health care coverage be included in all health insurance policies:

"Mental health is part of a person's overall health. It is an illness of the brain, and the brain should be covered."

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.