When the bipartisan Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law in 2008, mental health advocates hoped it would begin bridging the gap between the way that mental health treatments and more “traditional” medical services are provided — particularly by prohibiting different standards for one type of care over the other. Unfortunately, the evidence shows there’s still a long way to go when it comes to making the dream of medical parity a reality.
Time’s new Mayo clinic-sponsored report points out that ADHD, while being increasingly diagnosed and treated in children, has lingering long-term effects on adults and is a strong indicator of co-occurring mental illnesses for both children and adults. But lax insurance requirements, as well as a lack of awareness about the long-term effects of mental illness, have led to a dearth of research regarding the comprehensive effects of what medical professionals tend to dismiss as a childhood behavioral disorder:
It’s not that the condition isn’t being addressed adequately, or that doctors, parents and teachers are not aware of the condition: they certainly are, since education and awareness about ADHD has increased in recent decades, even contributing to a rise in diagnoses… [Dr. Barbaresi of Boston Children’s Hospital and Mayo Clinic] argues, however, that the legacy and long term implications of an ADHD diagnosis haven’t really been considered and studied adequately, since most doctors tend to think of the condition as one that primarily affects children that they tend to outgrow once they reach adulthood. The need for attention is even greater considering that the study also found a connection between ADHD and suicide. While the absolute number of deaths in the adults who still have ADHD is low, the statistical difference is significant: children with ADHD were nearly five times more likely to die from suicide than other people in the study group. [...]
In addition, data from this same group of study participants showed that more than 60% of kids with ADHD have a learning disability and develop at least one additional mental-health problem while they’re still children. Yet insurance companies are reluctant to authorize additional assessments that may detect and treat these conditions. “If a child gets diagnosed with ADHD, we want to do a comprehensive psychological assessment to see if the child has undiagnosed disorders because we know these kids are at risk,” says Barbaresi. “But insurance won’t pay.”
That’s in stark contrast to the way that children are evaluated for other medical conditions, such as diabetes. “We know they’re at risk for developing kidney and eye problems so they’re regularly assessed for those issues. We don’t wait until a child has renal failure or loses his eyesight,” says Barbaresi. “But with childhood ADHD, we can’t get authorization to do these assessments until it’s already happened.”
The Mayo study on ADHD underscores the practical hurdles of enacting true parity between the ways that mental health disorders and more “traditional” medical problems are diagnosed, treated, and even researched. Societal stigmas and decades of traditional medical practice have perpetuated a system in which mental health disorders are considered to be unique, individualistic medical problems — they are not — that ignores the interplay that mental disorders have with other medical conditions, not to mention the physical manifestations of such disorders.
Much of the focus on changing this unacceptable status quo has — justifiably — concentrated on funding and access to mental health care services. For instance, between the Wellstone-Domenici law and Obamacare’s requirement that statewide insurers include mental health coverage as an “essential health benefit,” millions of Americans are expected to gain access to mental services:
That is undoubtedly a step in the right direction. But the mental health benefits that states must provide under Obamacare are left largely to states’ discretion — and there is little reason to expect that states will impose strict requirements on insurers since mental health is still largely considered a form of “specialty” care culturally, if not legally, and private insurance doesn’t tend to cover patients’ out-of-pocket psychiatric costs. Bringing true parity between mental and physical health care necessitates a paradigm shift in the very culture of how such conditions are analyzed, approached, and treated, in addition to stricter insurer requirements for providing comprehensive care.
Armed with more data from longitudinal studies about the long-term effects and complex interactions of mental health problems — such as the Mayo ADHD study — health care professionals could substantially improve the lives of millions of Americans, and help eliminate a dangerous medical inequality and stigma in the process.