Mental health and substance addiction treatment has long been the stepchild of the U.S. health 
care system – but that may finally change, if former Rep. Patrick J. Kennedy (D-RI), an advocate for increased spending on mental health and addiction problems, has his way.
While the U.S. spends $2.6 trillion annually on physician care, hospitalization, surgery and pharmaceuticals, only a small fraction goes to treating Americans who suffer from psychological and mental problems as well as drug and alcohol addiction.
Public and private mental health spending totaled about $150 billion in 2009, more than double its level in inflation-adjusted terms in 1986, according to Health Affairs. But the economy also nearly doubled in that time. Direct mental health spending has remained roughly 1 percent of the economy since 1986, while total health spending climbed from about 10 percent of GDP in 1986 to nearly 17 percent in 2009, according to a New York Times analysis.
This outsized disparity in health care expenditures has persisted over the past decade, when Americans struggled with the emotional fallout from the recession and the wars in Iraq and Afghanistan. Nearly 36,900 Americans commit suicide each year, and many of them are either unemployed, students in college, active military members or veterans.
“As a nation, we ought to be really focused on this, because we know 90 percent of those who take their lives are suffering from an underlying mental illness or depression,” said Kennedy in an interview last week. “We can make an enormous difference in preventing these suicides if we treat mental health issues like we would any other physical health issue.”
Along with fellow mental health care advocates, Kennedy says the stigma associated with these issues helps explain why, over the years, the government, insurance industry and business have given short shrift to the plight of those suffering from mental problems.
THE FIRST BREAKTHROUGH
The first wave of change came in 2008, when Kennedy and former senator Pete V. Domenici (R-NM) and the late senator Paul Wellstone (D-MN) helped enact the Mental Health Parity and Addiction Equity Act. The legislation heightened awareness and made it somewhat easier for Americans to access mental health and substance abuse services.
The law doesn’t require insurance plans to cover mental illness or substance use disorders in general. But companies with more than 50 employees and government insurance plans that do offer coverage must guarantee it is on a par with more general medical coverage, including co-payments, deductibles and out-of-pocket maximums.
Federal and state authorities were slow to draft rules and implement the legislation, according to Kennedy and others. Most employers covered by the legislation only began adhering to the rules in 2011, and results were mixed.
Now, if undeterred, the Obama administration’s Affordable Care Act will take that parity legislation one step further.
HOW OBAMACARE WILL CONTRIBUTE
Obamacare – assuming it survives the GOP challenge this fall – will provide the largest expansions of mental health and substance use disorder coverage in a generation, according to the Dept. of Health and Human Services.
Beginning in 2014, small businesses that offer healthcare with 50 or fewer workers and individual market plans created after Sept. 23, 2010, must cover 10 essential health benefit categories, including mental health and substance use disorder services – and cover them on a par with other medical benefits.
While most large group plans and most small group plans include coverage for some mental health and substance use disorder services, there are coverage gaps and many people don’t have federal parity protections.
Overall, 32.1 million Americans will gain access to mental health and addiction coverage, while another 30.4 million who currently have some of this coverage will gain federal parity protection, according to HHS.
Judith Bentkover, an adjunct professor of community health at Brown University, said federal and state government officials have been slow to implement the Mental Health Parity and Addiction Equity Act. But she’s optimistic that “Obamacare will bring more people into the system. … I think that as people now have the means to get [mental] illnesses diagnosed and treated . . . this will be good for that segment of the population.”
“We need affirmative action for mental health since it’s been at the back of the bus for a long time,” said Kennedy. “We still to this day have persistent discrimination against people with mental issues.”
A LEGACY BROADENED
Kennedy is sponsoring a two-day event at the JFK Presidential Library in Boston on Oct. 23 and 24, to commemorate President Kennedy’s signing of the Community Mental Health Act of 1963. That landmark legislation provided federal funds for community mental health centers and paved the way for deinstitutionalization of the mentally handicapped.
“I am obviously trying to galvanize this 50th anniversary of my uncle signing this important law to try to raise the profile of where we are today, in comparison to where we were 50 years ago, and try to create the environment whereby this cannot be something that is slipped under the rug,” Patrick Kennedy said.
The son of the late Sen. Edward M. Kennedy of Massachusetts, Kennedy is more than familiar with mental health and drug addiction problems. In May 2006, while a member of Congress, he crashed his car into a traffic barrier on Capitol Hill in the early morning hours. He said at the time he was apparently disoriented because he had been taking Ambien, the sleeping pill, and another medication.
Kennedy has acknowledged being treated for cocaine use as a teenager and abusing drugs and alcohol while a student at Providence College. He sought treatment for an OxyContin addiction in 2006. In a March 7, 2008, speech to the Cleveland City Club, he admitted having bipolar disorder and being a recovering alcoholic.
Kennedy, 46, served in the House from 1995 to 2011. He’s since been advocating for mental health and addiction treatment causes. He is co-founder of One Mind for Research, which seeks to increase resources and efficiency in brain disorder research.
Kennedy said he’s had the support of his wife, Amy Petitgout, and other family members in battling personal health problems. “I am in a good place in my mental health,” he said.
He also said, “I have a chronic illness, which means I can only address it on a day-to-day basis. I’m never cured. My first priority every day is to make sure my own mental health is in good shape.”
