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Equitable Access to Mental Health Care

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Equitable Access to Mental Health Care SPRING 2021 NEWS VOL 14 ISSUE 1 Equitable Access to Mental Health Care FAR TOO MANY OF US do not have access law by embracing the landmark verdict action lawsuit tried in October 2017 that to the mental health care we need, even if in Wit v. United Behavioral Health (UBH) charged UBH with breach of its fiduciary we have health insurance, and especially (discussed later in this piece). duty to its insureds when it used overly if we are members of a minority group. restrictive access to care guidelines to Efforts to achieve true mental health parity Legislation deny mental health and substance use through legislation and litigation, as well By way of background, the Mental Health treatment. The court found that UBH as individual and organizational advocacy, Parity and Addiction Equity Act (MHPAEA) focused excessively on crisis stabilization are central to addressing these health was signed into law in 2008. This important rather than appropriate treatment of disparities and increasing access. piece of legislation made clear: if an patients’ full clinical pictures. In November insurance policy covers mental health and 2020, in the trial’s remedy phase, Chief substance use disorders, then the barriers Magistrate Judge Joseph Spero issued Mental health parity describes the to access treatment cannot be substantially a stinging rebuke to UBH, compelling equal treatment of mental health conditions more stringent than those to access them to reprocess over 50,000 claims and substance use disorders in insurance medical and surgical care. In other words, and imposing a 10-year injunction against plans. (Definition courtesy of NAMI) the quantitative (e.g., number of office visits UBH during which a court-appointed or inpatient days) and non-quantitative Special Master will oversee and correct (e.g., hurdles like prior authorization or UBH practices. This major victory for Medical Director/CEO Eric M. Plakun, concurrent review) limits applied to access mental health parity was hailed as a “game MD, has been a vocal and effective to mental health care must be comparable changer” by former Congressman Patrick advocate for mental health parity, both to those applied to medical coverage. Kennedy, and not only for those involved at Austen Riggs and in his leadership The “Final Rules” of the MHPAEA and the in this case. More than good news, the positions in the field of psychiatry. In fact, Affordable Care Act (ACA) both helped verdict is also a powerful tool for individual Dr. Plakun was recently re-elected to a strengthen the parity law, but enforcement clinicians and patients appealing denials second three-year term as the American to-date has been inconsistent and minimal. of medically necessary care, as well as for Psychiatric Association (APA) Area 1 Litigation is now helping to remedy this. professional organizations that can use the Trustee, running on a platform largely verdict to reassert their authority over the dedicated to reducing health disparities, Litigation proper elements of access to care criteria. increasing access to care, and more fully Wit v. UBH (in which Dr. Plakun served as implementing the mental health parity plaintiffs’ expert) is a landmark federal class continued on page 2 From the Medical Director/CEO, p2 / Clinical Scholarship, p3 / Alumni Social Gatherings, p3 Media Prize Call for Entries, p3 / Virtual Learning and Events, p4 Equitable Access to Mental Health Care continued from page 1 Individual & Organizational Advocacy The Wit v. UBH ruling curbs the power of insurance companies to From the decide what standards of care are consistent with generally accepted standards. If professional organizations join the court’s assertion Medical Director/CEO that real treatment is more than crisis stabilization, there is hope that the impact of the verdict will extend beyond UBH to other ERISA (employer) insurance plans, to commercial insurance, Affordable Care Welcome to the spring 2021 issue of the ARC News. Last Act, Medicare, and Medicaid plans, thus increasing access to care, year at this time, we had just begun to feel the impact more fully implementing parity, and reducing health disparities. of the pandemic and all that came with it. The collective, Individual caregivers can also harness the verdict to advocate for global losses have been devastating, and more than half and advance access to medically necessary care for their patients. But, a million of our fellow citizens have now succumbed, but that may be easier said than done. Fortunately, there are a number the increasing availability of vaccines is helping to build of excellent resources available to help, including a 4-point toolkit Dr. a bridge toward hope. Plakun developed for appealing denials of medically necessary care, Here at Riggs, I am happy to report that over 90% of referenced below. Knowing clinicians’ and patients’ rights and how to our staff and patient community has now received two exercise them are critical parts of achieving mental health parity. doses of the Moderna COVID-19 vaccine. We remain vigilant but hopeful that our open setting, our therapeutic Use the patient’s voice community, indeed, all the elements of our unique as a party to a binding contract. treatment setting and its network of relationships will 1 begin to look and feel more “normal” again soon. Anchor appeals to In these pages, you’ll read about issues that Riggs cares third-party resources. deeply about and that I have been working toward for 2 some time: implementing mental health parity, increasing access to care, and reducing health disparities. I’ve never 3 Invoke the parity law. been more optimistic about the direction we’re headed, but also recognize there is much work still to be done– Reference the work that we can do together, whether we’re providing or 4 Wit v. UBH verdict. accessing care (or know someone who is). You’ll also read about a renewed effort–thanks in Specific details on how to use these four points can be found at large part to an anonymous donor–to help former Riggs www.austenriggs.org/4Tools patient alumni connect through virtual social gatherings. Maintaining relationships with one another has been a challenge throughout the pandemic, but virtual spaces Additional Resources have also created new opportunities. For example, as you will see on page four, our broad There are countless resources on mental health parity–a cursory array of Erikson Institute lectures and events, most of internet search will bring up many guides, toolkits, videos, and more which offer free continuing education credits, can now from reputable government, professional, and non-profit entities. be accessed anywhere in the world through the internet. A select few are listed below: We hope you’ll join us on Zoom to take advantage of our National Council for Behavioral Health has toolkits, trackers, on-demand course library, which we are adding to regularly. templates, and more for providers and patients to utilize: Finally, I want to thank all our generous donors and www.thenationalcouncil.org/topics/parity supporters who helped make our 2020 annual fund drive a success. In whatever way you are connected to the Austen Riggs Center has compiled a number of articles, webinars, Riggs community, your support is critical to our success. videos, and more related to the landmark Wit v. UBH case and its implications for mental health parity: With gratitude, www.austenriggs.org/Parity-News-and-Resources American Psychiatric Association has a printable poster, templates, and much more: www.psychiatry.org/psychiatrists/practice/parity Eric M. Plakun, MD American Psychological Association has a good overview of the Medical Director/CEO parity law as well as consumer and employer guides: www.apa.org/topics/managed-care-insurance/parity-law-resources 2 Clinical Scholarship Ridenour Lewis Pitman Knauss Riggs staff members Jeremy Ridenour, PsyD; Katie Lewis, PhD; Seth Pitman, PhD; Dan Knauss, PsyD; and their collaborative research partners at Mass General Hospital and the University of Michigan-Dearborn recently published “Card Pull Effects of the Thematic Apperception Test Using the Social Cognition and Object Relations-Global Rating Method on Complex Psychiatric Sample” in Clinical Psychology and Psychotherapy, a first-of-its-kind study An Opportunity for that seeks to understand how male and female patients respond differently to TAT (Thematic Apperception Test) cards–important work Riggs Alumni to Connect that may help reduce bias when interpreting TAT stories. Quarterly Alumni Zoom Social Gatherings for Former Patients Austen Riggs Center Staff Psychologist and Thanks to generous underwriting Team Leader Marilyn Charles, PhD, ABPP, was by an anonymous donor, Riggs will be recently named the winner of the American Board holding quarterly virtual forums for & Academy of Psychoanalysis (ABAPsa) Book Prize for 2020 in the Applied Category for her book, former patients to engage and express co-edited with Jill Bellinson, PhD, entitled The themselves in healthy and supportive ways. Importance of Play in Early Childhood Education: Psychoanalytic, The virtual social gatherings take place Attachment, and Developmental Perspectives (Routledge). It presents several theories of play and demonstrates how play serves from 7:00-8:30 p.m. (Eastern Time) communicative, developmental, and relational functions, while and are held on the following Tuesdays: highlighting the importance and development of the capacity to play February 23 • August 31 in terms likely to be useful to early childhood
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