Can`t stop the fight for equity

The Friday afternoon when Congress and President Bush successfully concluded 12 years of toil in the behavioral health field over insurance fairness provided stirring theater for those of us who have chronicled parity's ups and downs. By early the following week, after all the media statements from weary but satisfied advocates had streamed in, you could almost feel a bit of a letdown from the initial euphoria.

Looking back now, I realize it would have been foolish to expect a ticker tape parade in the addiction and mental health communities. After all, the parity saga—and it sure felt like one sometimes—gave us some striking reminders: that this field must consistently fight for what is often routinely handed to others, and that there is always more heavy lifting to do on behalf of the addicted and the mentally ill.

As uplifting as we find enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, those words “parity” and “equity” won't be fully realized for months, maybe years. Insurance plans in policy years that begin after Oct. 3, 2009 will have to be transparent in the terms of their addiction/mental health and medical/surgical benefits, but will parity's implementing regulations fully support the law's goals? Will any insurance benefits be watered down across the board in order to keep anticipated cost increases in check? And will consumers be aware of their rights and know where to turn when these are compromised?

I asked several advocates in recent weeks to talk about the collective mood of their colleagues since parity's adoption, and relief is cited more often than elation. One called the completely unexpected connection to the financial rescue legislation that finally brought parity forward “a humbling reminder that you're always at the whim of ‘politics,’ broadly understood. As advocates, we can only do our best and hope that the stars align.”

Another advocate mentioned the ambivalence that remains over what the addiction and mental health fields couldn't win during the debate, such as mandated behavioral health coverage in insurance plans or a specific reference to all DSM-IV diagnoses in parity language.

As Daniel Guarnera indicates in his article in this issue, access to comprehensive services won't mean that these services are utilized unless and until consumers are educated, empowered, and protected.

Finally, it would be a shame if the addiction and mental health communities don't parlay this legislative victory into a larger effort to maintain lines of communication and seek common ground on other important issues. It is worth remembering that many are giving the largest share of credit for the parity outcome to U.S. Rep. Patrick J. Kennedy, who was able to humanize his struggles with both addiction and bipolar illness and to argue that all citizens deserved the same high-quality care afforded to him. To build on this historic victory, it is high time for addiction and mental health professionals to realize what they have in common and to test the limits of collaboration.

Gary A. Enos, Editor

Clarification

The Prince William County, Virginia project described in the article “Technology transfer on Main Street” in the September/October 2008 issue was funded in part by cooperative agreement 5UD1T1013415 from the Center for Substance Abuse Treatment (principal investigator Paula K. Horvatich, PhD). Author Denise Hall would like to thank Keith Schuster and the administration and staff at the Prince William County Community Services Board for their participation.