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Posted by on Oct 29, 2008 in Health, Society | 7 comments

Mental Health: An Interview with Rep. Patrick Kennedy

Our family and others have long believed that mental, neurological, and related ailments should be treated on par with physical/biological disorders.

The Mental Health Parity Act of 1996 started the process by prohibiting health plans from offering lower annual/lifetime benefits for mental health than physical health. Unfortunately, as a result, many health plans complied with the law by imposing other treatment limits or requiring higher co-pays for mental health care.

Enter Rep. Patrick Kennedy (D-RI), the youngest child of longtime healthcare reformer Sen. Ted Kennedy (D-MA). Inspired, in part, by his own struggles with mental health/addiction issues, Rep. Kennedy became — along with the late Sen. Paul Wellstone (D-MN) and current Sen. Pete Domenici (R-NM) — one of the champions in Congress who worked to close the 1996 Act’s loopholes and thus ensure that the parity in coverage offered to Members of Congress and their families is offered to other Americans as well.

After a long fight, in which Kennedy and his colleagues drew close to their goal multiple times, they finally succeeded this year, with enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Of 2008.

Yesterday, I had an opportunity to speak briefly with Congressman Kennedy about this accomplishment and where he’d like to go next in advancing mental health care.


The Moderate Voice: The passage of this legislation represented a milestone in a long journey for you and many others. How does it feel to have finally succeeded?

Rep. Patrick Kennedy: There’s no way to completely dismantle the stigma associated with mental illness. But there was a way for us to change the law. And that’s what we did. And by changing the law, we began to dismantle the stigma because we made it illegal for people to discriminate. In doing so, we’re starting to change the practice of delivering mental health coverage and mental health services. For people like me who suffer from mental illness, this is about lifting the cloud of stigma and shame associated with our illness. As much as we have come forward as ‘stigma-busters,’ it’s hard to not feel the tinge of judgment that people make on mental illness.

This law is important, first, because people know they’ll get treated. It’s also important because they can feel better about asking for and demanding treatment — because they’re entitled to it.

TMV: What’s the most compelling argument you can make to someone who might be concerned about the private and/or public sector costs this legislation might create?

RPK: The CEO of Blue Cross/Blue Shield of Rhode Island testified in favor of this legislation. He also testified that the problem was not over-utilization but under-utilization of mental health benefits. We need people with mental illness taken care of because it saves us money. If someone is depressed or suffers from another mental illness, their other health care costs (could) quadruple. They’re at higher risk for heart disease, diabetes, and so on. You have to address their mental illness if you want to address their other ailments.

We heard testimony around the country that a significant portion of weekend intakes at emergency rooms are by and large for trauma cases due to drugs and alcohol. We deal with those cases as criminal justice problems rather than health problems. And we pay for those costs in other ways — in our criminal justice system and in our healthcare premiums.

Then, of course, you’ve got the issue of lost productivity at work. If you want proof of the merits of this legislation, consider that the top Fortune 100 companies have been providing generous mental health benefits for years. They’ve done all the studies and determined that it’s a plus for their bottom lines. They see their overall health care costs go down and productivity rates of employees go up when they offer robust mental health benefits. The proof is in the pudding.

TMV: As I understand it, the current bill is not a mandate to offer mental health benefits. Instead, it’s a mandate that, if an insurance company already offers mental health benefits, it must then offer them at parity with physical health benefits. Are you at all concerned that this requirement might discourage insurance companies from offering any mental health benefits?

RPK: No. If we had mandated coverage of (the entire diagnostic manual), this bill would not have become law. Part of our compromise was to let employers and insurance companies determine what they would cover, with medical necessity as the determinant of the day, not arbitrary selectivity.

Our fall back position is that we want the GAO to study the patterns of mental health coverage going forward … to see how widely mental health diseases are being covered. If the GAO determines those diseases are insufficiently covered, we’ll have to come back and shore up the law.

Also, we have very strong language in the law defining “medical necessity” and how to determine a patient’s eligibility for mental health coverage, so that when people sign up for coverage, they know what the grounds are for denying coverage, strengthening their ability to appeal arbitrary decisions.

TMV: What’s next? This legislation has defined your health care agenda for many years — what replaces it in the years ahead?

RPK: I’ve got a lot of plans, including for veterans’ health. Today, the VA measures almost every disease except certain mental illnesses such as addiction. As a result, we don’t have outcomes-based metrics to determine what’s working in terms of therapeutic interventions. If the VA was required to track large populations for mental health ailments, we could learn so much to help us develop outcomes-based metrics, evidence-based care. I will work to provide the opportunity for full physical and mental health screenings for every veteran coming out of the service. This will help avoid problems that crop up later. Prevention is the best cure.

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  • AsherJ

    It’s quite likely that within 10 to 15 years we’ll be able to screen fertilized fetuses for propensity for mental illness. Unfortunately, this rationalist-scientific approach to mental illness will be adamantly opposed from both ends by leftists, who desperately cling to the blank-slate ideology that all human suffering is caused by socially constructed oppression, and evangelicals, who think that all life is sacred, having been created by God.

  • HaroldAMaio

    Harold A. Maio (retired)

    Advisory Board
    American Journal of Psychiatric Rehabilitation
    Former Board Member
    Partners in Crisis
    Former Consulting Editor
    Psychiatric Rehabilitation Journal
    Boston University
    Language Consultant
    UPENN Collaborative on Community Integration
    of Individuals with Psychiatric Disabilities
    8955 Forest St
    Ft Myers FL 33907
    [email protected]

  • HaroldAMaio

    There’s no way to completely dismantle the stigma associated with mental illness.

    Dare you to print that about rape. Women are not as timid as Kennedy. Thousands of indignant letters would reach you instead of this lone one.

    Kennedy of course errs, our society dropped its prejudices several times, this particular prejudice is already on a steady course for total demolition.

    Harold A. Maio (retired)

  • Guest

    Harold Maio — Not sure I understand your point.

    I do believe the Congressman, as someone who has personally endured such stigma, simply meant that Congress could not eliminate that stigma but could take steps to help lessen its occurence, i.e., give comfort and courage to those who suffer from mental illness by showing them that their struggles will be treated — in law and in society — no differently than physical ailments.

    Net: You, the Congressman, me, and many others — we all believe such stigma is unfair, but that doesn’t mean it will ever be permanently erased. Unfortunately, there will always be ignorance; and where there is ignorance, there is prejudice; and where there is prejudice, there is stigma, no matter how wrongly applied it is.

    The Congressman’s not defending such stigma, he’s only speaking honestly about it, as one way to understand the importance of this legislation. That’s productive, I think.

  • dianalo

    I had no idea there were any questions about if there were a stigma to mental health issues. Of course there is a stigma attached! People discuss cancer, heart disease and other important illnesses in quite a different way than they do mental health.
    Hopefully, as people learn more, they will better understand mental health issues and will not treat them as less important than more obviously visible ailments.
    To say there is no stigma only discounts the problem and makes it worse. Denying the stigma does not erase it.

  • JSpencer

    “We need people with mental illness taken care of because it saves us money.”

    Absolutely. Like so many other medical problems, the ounce of prevention applies. And why should there be any stigma? (even though I know there is) Just look at this world around us and the way supposed rational people behave in so many outlandish and sociopathic ways, yet there is no stigma for them! This nation is so badly in need of growing up. I’d love to see a few signs of it in my lifetime…

  • Nice job Pete!

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