Do we really want parity?

 

You have heard it before - we need parity for mental health and physical health. There is even federal law that mandates insurances do not impose less favorable benefits for mental health treatment. So why do advocates still say we need parity?

Hot Take: it's not parity people want. 

Yes, people want parity in regard to payment. The United States healthcare industrial complex is big business. It is natural that mental health entrepreneurs, leaders, and providers want a piece of the action. There are many benefits for rates that are par with physical health including a more livable way for providers in the community mental health system and improved sustainability for those working with the most difficult to serve clients. 

What I don't think advocates want are the number of other things that are commonplace in physical health. We hear the horror stories of doctors not getting certain procedures approved by insurance companies and while denials happen in the mental health space it is different. With the increase in value-based care, are mental health providers ready for a reduced rate when their client is not improving? What happens when clients do not improve at the expected rate? When a client is denied hospitalization due to a 30-day readmission, what will the mental health system do? There are even more adverse implications when we talk about SUD treatment.

Parity with physical health could mean more capped sessions or dictated treatment modalities. It could mean manualized treatment and decreased provider autonomy to allow for a more robust response to client need. Parity will require some tradeoffs and those tradeoffs can fundamentally respace how mental health treatment is delivered. 

I don't know every situation and I am not saying parity is not needed. I do think the use of the word parity in advocacy efforts has become more rhetoric than getting at what people actually need. Fundamentally, mental health treatment in this country needs to be valued, funded, and appropriately compensated for what it is. Healthcare in the United States does not work for so many people. We shouldn't base our desire for parity on a system that puts profit over people. We need to question the terms we use and clarify what we mean.