Connecticut has long been a national leader in how we view and deliver mental health and substance use disorder treatment. We have been at the forefront for many years of legislation known as “parity” that puts these health conditions on equal footing with physical health. Our roots in this field go all the way back to the grandfather of mental health reform, Clifford Beers, who was from New Haven and founded the first-of-its-kind nonprofit that became Mental Health Connecticut in 1908 before founding Mental Health America a year later. In 1913, Beers also founded what is now known as the Clifford Beers Clinic in New Haven.
In recent years, our status as a leader on this issue has begun to slip. Connecticut’s ranking from Mental Health America for quality and availability of mental health and substance use disorder treatment has dropped from No. 1 in 2014 to No. 5 in 2018. As recently as a decade ago, Connecticut frequently broke new ground in mental health and substance use disorder legislation and enforcement. In recent years, other states have largely assumed this role. Meanwhile, our state legislature failed to pass a parity bill last session designed to enforce current laws, and our executive branch has not taken a visible and forceful stance on enforcement in a number of years.
As a state that is in some ways in search of an identity, care for mental health and substance-use challenges is something we can claim as a strength. Whether that continues rests in the hands of candidates currently running for state office and the voters who will elect them.
It is vital that we continue to advance how mental health and substance use disorders are viewed and treated because there is still so much ground to cover. “Parity” refers to the legal requirement that insurance coverage and access to mental health and substance-use disorder care and services must be comparable to, or “on par with,” what’s provided for medical and surgical care. Despite parity laws at the state and federal level, parity is still very much an ideal and not a widespread reality.
One way to measure parity is by how often individuals must seek care from out-of-network providers. A recent comprehensive study showed that Connecticut residents are 10 times more likely to receive care from out-of-network behavioral health providers than they are for primary care.
In addition, preventative mental health and substance use disorder care is often given lip service, but rarely funded. Even in our state which clearly values this issue, we opt for the much greater —if delayed— expense of treating these conditions once they reach a critical point rather than providing opportunities for residents to maintain good health and save taxpayer dollars.
The state legislature will again consider a stronger parity bill this upcoming session and we encourage lawmakers to pass it. However, there is no need to wait for new legislation to affect change. With the laws that are currently on the books, the winners in this November’s election can make mental health and substance-use parity and prevention priorities on day one, if they have the will to do so.
We’ve seen how investigations can have powerful effects. For example, in 2002, the Connecticut Attorney General’s Office issued a report concerning Psych Management Inc., which found that Connecticut residents were unlawfully being denied inpatient behavioral health services and subjected to inappropriate outpatient care limits. The wrong was righted, and the system improved.
There are a number of factors that enabled this action and others like it, here and across the country. First, we need strong legislation, which we have, though it could be stronger. Second, the governor and his appointees to the Insurance Department and Office of the Healthcare Advocate must visibly and actively support equal delivery of health care services. Third, the Attorney General needs to make enforcement of parity laws a priority. The best laws in the world are useless without enforcement.
In short — there is no reason our state can’t continue this important work which helps residents get the care they need, saves the state money, and leads the way for the rest of the country.
One in five adults in the U.S. – approximately 43.8 million people – lives with a mental health condition. This is something that affects every family and every community. We ask candidates from all parties to commit to building on Connecticut’s strength in the mental health and substance use field, and we urge voters to hold their candidates accountable on this issue.
Arnold Menchel is Chair of the Healthcare Practice of Halloran Sage. He was previously an Assistant Attorney General for the State of Connecticut for 33 years and was the head of the Connecticut Attorney General’s Health Care Fraud/Whistleblower/Health Care Advocacy Department.
Luis Perez is President & CEO of Mental Health Connecticut, a service, education and advocacy nonprofit with six offices across the state dedicated to improving the mental health of all Connecticut residents. He has worked in both the public and private sectors and is a Licensed Clinical Social Worker.