Parity, Not Parody

Chris Bouneff

On Monday, The Oregonian came out with some strong words for the Republican leadership in the House over the issue of mental health parity. And justly so. What this Legislature, or more specifically Karen Minnis and Wayne Scott, are doing to this monumental piece of legislation is a pure tragedy.

I work for a mental health agency that treats children and families from across Oregon. In my short time here, I've collected dozens of stories just like the ones that The O's editorial highlighted.

The overwhelming number of children who we treat are on a government assistance program, such as the Oregon Health Plan. This isn't because children from families with access to private insurance don't suffer from mental illness. They do, and in the same numbers as children in all economic situations. But children with OHP coverage get something that other children don't -- adequate benefits that allow my agency and our peer agencies to treat them properly.

Thanks to OHP and other programs, children and families have access to everything from high-end services such as residential care to less restrictive services such as outpatient therapy and in-home therapy. This care is clinically effective and cost effective. Our team of psychiatrists, psychologists and therapists can do a proper assessment and implement a treatment program that truly benefits the child and family.

This is important to note because often the worst thing a child and family can have is private insurance coverage when it comes to mental health care ­-- because families are trapped in a system that only pretends to assist them when they most need it. With few exceptions, private insurance benefits are woefully inadequate, as if insurance companies fear that a child and family will receive the proper course of treatment and begin to effectively manage any ongoing mental health needs.

So just as The O depicted, we have families who choose to give up custody of their children to the state so that their sons and daughters qualify for state assistance. Their private insurance won't help, and they've exhausted all of their financial resources. It's a hell of a thing to turn your child over to the state, but what choice do they have? They have nothing left.

With parity, many children can get the help they need before they escalate into more dangerous behaviors, which is an important point that The Oregonian's editorial missed. The piece focuses on worst-case scenarios, but more likely are the situations that one of our families in treatment faced.

This is the story of a girl who was in third grade when she and her family first came to our agency. She was referred to us by her local school district because of her impulsiveness and aggressive behaviors. School staff had placed her in every environment available, and she still needed more to be successful.

As it turned out, she needed a complete assessment from a child psychiatrist and proper medication management. Some follow-up care and in-home family therapy also was needed. But overall, she would have been a relatively easy case.

She qualified for health benefits under her parents' employer-provided health insurance. But the benefits were so limited that there were only three psychiatrists that the insurance company would allow her to see. Two lived outside her region, and the third was booked up months in advance. The family didn't have the financial resources to pay for care without insurance, and because of insurance restrictions, we had to turn away this family.

The girl's condition progressed because the family lacked access to proper services. Eventually, the girl was admitted to our agency's residential care program. Once there, our child psychiatrist could do a complete assessment, but even then it was her family physician who officially prescribed the proper medication because of insurance company restrictions.

Once the proper medication management occurred, she quickly improved. Some follow-up care was necessary, and today the family is on the path to good health.

The insurance company ended up paying for it all. Their bottom line? The company spent more than 10 times the cost of allowing the family direct access to services. That's the cost in hard dollars and doesn't account for the financial and emotional costs of injuries to family members, school staff, the girl's babysitter, and others who bravely tried to help this girl — not to mention the suffering this young girl had to needlessly endure.

Under parity, the family could have seen our child psychiatrist with a referral from their family physician. One appointment later, the girl would have had the proper medication management. Then after a couple of more outpatient and family therapy appointments, the family would have completed treatment.

Thirty-five other states have parity, and they've managed to control costs while opening access to families in search of effective treatment. It's the same system that sends you to an orthopedist when your knee goes out or to allergist when sneezing doesn't stop. Or to a cardiologist when your heart is at risk. What works for the medical side also works the for mental health side.

This is why those of us who advocate for children with mental health conditions are so outraged. The game of politics has turned real lives into a trading card for House leadership -- real lives that are at risk.

Can't we just put politics aside just this one time? Thirty-give other states have parity, and many lives are better for it. Why not make Oregon the 36th?

By Chris Bouneff June 14, 2005