Guest View: Joe Kennedy III Real mental health reform must move beyond margins

C ommunity health centers that say even if they could afford to hire 200 new mental health professionals, their caseloads would be full within the week ...

Insurance companies that refuse to approve mental health coverage on weekends, leaving patients in emergency rooms for several days ...

Emergency room directors, who can find an in-patient bed for someone facing a physical ailment in just three hours but who spend nearly a full day finding a place for a patient with a mental health crisis ...

Parents forced to work as full-time caseworkers for their own children ...

Children refused the care they need because outdated government regulations put limits on their treatment ...

This is the heartbreaking reality I heard echoed in a series of discussions I held in our communities for Mental Health Awareness Month. The physicians, families, community health centers, hospital CEOs and advocates who met with me gave a stark picture of the state of mental health care in our commonwealth and country.

They detailed a vastly underfunded mental and behavioral health system that lacks the infrastructure required to deliver proper care to the 1 in 4 Americans struggling with mental illness. They described insurance companies flouting parity laws and denying coverage for critical mental health services with little to no explanation. They spoke of a severe workforce shortage and Medicaid reimbursement rates so paltry that providers risk losing money every time they see a patient.

It was a timely discussion. Down in Washington, Congress is in the midst of a debate over how to respond to our country’s growing mental health crisis. Led by the Energy & Commerce Committee on which I serve, we are trying to craft bipartisan solutions for a system plagued by lack of access, funding and stability.

Any comprehensive reform effort must move beyond the margins and attack the systemic inadequacies deeply entrenched across the entire continuum of mental health care. First, we have to put teeth behind the federal laws that require insurance companies treat mental health the same way they treat physical health. Referred to as “parity,” these laws were intended to ensure that depression, schizophrenia and addiction are covered to the same extent as cancer, diabetes, or a broken leg. Despite having these laws on the books, however, mental health claims are denied today at nearly twice the rate of physical health claims, often with no explanation.

Earlier this year, I introduced the Behavioral Health Coverage and Transparency Act, which would force insurers to disclose how often they deny mental health claims as well as the criteria used to make those determinations. This information would help empower patients to demand the care to which they’re entitled. Additionally, this bill would require federal regulators to undertake a certain number of random health plan audits each year to discourage skirting the law and would establish a Patient Parity Portal, where patients can access coverage information and lodge complaints when they are unfairly denied coverage.

Our health care system doesn’t wait until someone has Stage 4 cancer to offer treatment; those struggling with mental illness deserve the same.

Second, the federal government must address abysmal Medicaid reimbursement rates, which disproportionately jeopardize care for our most at-risk populations. As the single largest payer of mental health services in the United States, Medicaid’s current reimbursement rates are shortchanging providers and patients alike by eliminating incentives to accept new patients, stunting our mental health workforce across the board, and closing off pathways to care for low-income families that often have nowhere else to turn. The impact of this has been profound; over half of all counties in the United States have no practicing psychologists, psychiatrists or social workers. With that in mind, I’ve introduced legislation called the “Medicaid bump,” which would help address this gap and encourage states to increase mental health spending by raising federal reimbursement rates.

These are two essential pillars of systemic reform. But there are many more. We need to fix outdated federal regulations that currently say a child in Medicaid who requires in-patient care can receive treatment for either physical or mental health — but not both. We need to end Medicare’s 190-day lifetime limit on inpatient psychiatric hospital stays for senior citizens. And we need to finally and fully invest in the entire continuum of mental health care — not just the crisis-stage interventions we resort to in emergency rooms, courtrooms and jail cells at tremendous cost.

The pain that our broken mental health system has inflicted on countless American families and communities is immeasurable. Government at every level must work day and night to address the shortcomings that continue to allow tragedy and suffering to occur.

—U.S. Rep. Joe Kennedy III, a Democrat, represents Massachusetts’ 4th congressional district.