Mental Health Association of RI Releases Report

Mental Health Parity in Rhode Island: Experiences of Patients and Professionals

PROVIDENCE, RI – Today, the Mental Health Association of Rhode Island (MHARI) will present a report to members of the Governor’s Council on Behavioral Healthcare that highlights findings and recommendations from research conducted as a part of their RI Parity Initiative (RIPI).  The report – Mental Health Parity in Rhode Island: Experiences of Patients and Professionals – identifies several recurrent experiences patients and mental health professionals reported that demonstrate systemic discrimination by health insurers in paying for mental health services and treatment as well as persistent social stigma experienced by those with a mental health disorder.

Pam Testoni, a Rhode Islander with a history of mental illness that participated in the research, describes the ongoing social stigma experienced by those with a diagnosed mental health disorder, “When I was hospitalized and had to leave work, I didn’t hear from anyone. If I had gotten cancer, people would have been lined up with casseroles in my driveway. But nobody knew what to do. Nobody knew what to say. They haven’t been taught. Until we start teaching that, and we need to start with our youth, it’s going to remain a stigmatized illness.”

The majority of the 35 patients and 25 professionals that participated reported significant stigma in addition to barriers to care as a result of insurance carrier restrictions. As one participant stated, “it is demeaning to have to beg for some understanding…to get treatment for an illness.”

In 2008, Congress passed the Mental Health Parity and Addiction Equity Act intended to address this issue.  But, as Laurie-Marie Pisciotta, MHARI Executive Director, describes, “Despite the law’s central requirement that insurers cover mental health, including addiction treatment, no more restrictively than they do medical and surgical treatment, our findings show that insurers continue to restrict access to care through strategies such as arbitrarily limiting the number of days a patient can see a provider or denying residential treatment, among other strategies.”

Sam Salganik, Executive Director at the RI Parent Information Network notes, “Each year, RIPIN’s free Consumer Health Insurance Call Center helps thousands of Rhode Islanders with health insurance issues. We hear from clients every day about how difficult it can be to access mental health and substance use disorder services. As our experience and this report demonstrate, a lot of work remains if we are to achieve mental health parity.  The Consumer Health Insurance Call Center is here to help and we encourage anyone having trouble getting coverage they need to call us at 401-270-0101.”

Dr. Ernestine Jennings, a research scientist at Brown University, mental health clinician, and MHARI Board Member, oversaw the research.  She notes, “The overarching goal of the MHARI Parity Initiative’s use of focus groups is to help shape a broader understanding of the issue of stigma and mental health parity in Rhode Island and to incorporate the voices and ideas of patients and professionals in moving the aspiration of parity laws to true equality for patients.  We used accepted research practices in conducting the groups to help define prescient policy and regulatory recommendations that will help achieve real and systemic change.”

Among the report’s recommendations is a call to increase state funding for behavioral health systems improvements and expansion – particularly for outpatient services — and investment in efforts to change public attitudes about mental health.  Several recommendations in the report address the issue of network inadequacy.  Insufficient networks of mental health providers covered by health insurance plans are well documented in national research and are in part the result of lower insurer payments to mental health professionals than those paid to physical health providers for the same level of services.  One patient participant drew the comparison between physical and mental health services stating, “physical ailments, such as cancer, have a follow-up protocol. When a cancer patient is discharged they receive immediate care in terms of chemotherapy, surgery, or physical therapy, but when [someone is] discharged from a hospital with a mental health [disorder], where do [they] go?”

Following a major hospitalization, Pam Testoni recalls that her husband had to insist on an adequate aftercare outpatient plan, “There’s just no continuity of care after acute care in the hospital.  In my husband’s words, ‘patients are thrown to the wolves.’  I’m blessed to have had him to help and advocate for me because I never would have been able to do it out on my own, I just didn’t have it in me.”

One solution, MHARI recommends, is that the Office of Health Insurance Commissioner evaluate and mandate improvements in reimbursement rates in order to help incentivize introduction of needed services that currently are not broadly available in Rhode Island.

In fact, as Pisciotta notes, “with good regulation and oversight, we can make a real difference in the experience of patients and the availability of services.”  She points to the release in 2018 of the first of four market conduct exams of health insurers conducted by the Office of Health Insurance Commissioner (OHIC).  The exam of Blue Cross Blue Shield of Rhode Island (BCBSRI) resulted in innovative changes made by the insurer, including the elimination of utilization review for in-network behavioral healthcare services.  Utilization reviews are a strategy insurers use that force patients and providers to prove the need of a particular treatment.  Often, for hospitalized behavioral health patients, the reviews occur as frequently as daily unlike for those hospitalized with physical health conditions.  Both patients and providers report that these reviews are cumbersome, time consuming, frustrating, and can be a real barrier to the continuity of care needed.  As one provider participant noted, “Our work is [often] not what’s best for this patient. It’s, well, what will the insurance pay for?”

Jacqueline Burns from the Rhode Island Office of Mental Health Advocate describes it this way, “Among the problems with utilization reviews is that, while there are numerous non-behavioral health conditions where coverage is provided to maintain a patient’s condition, oftentimes the standards which are applied to behavioral health services require the patient to show that the service is improving their condition. We see many clients whose quality of life improves significantly when they are able to maintain their level of recovery.  More recently, courts are beginning to recognize that the behavioral health care community generally accepts that effective and optimal treatment can maintain functioning and prevent deterioration as an important and positive goal in and of itself.”

Peter Oppenheimer, a clinical psychologist and Chair of the Coalition of Mental Health Professionals of Rhode Island describes how a lack of parity impacts our overall healthcare system, “Mental health professionals and physicians have been advocating for a very long time to remove barriers and to gain access to the resources we need to serve our Rhode Island community. Our efforts to integrate mental health and substance use services with primary care, and to create a broad range of services flounder due to these barriers and lack of resources. Accessible quality mental health and substance use care could be the linchpin in Rhode Island’s efforts to implement a comprehensive healthcare system that meets the needs of our community. It’s time for Rhode Island to implement parity in practice.

For a copy of the full report, visit http://bit.ly/RIParityReport.

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MHARI’s RI Parity Initiative is supported with funds from the Rhode Island Foundation, the United Way of Rhode Island, and the Rhode Island Dept. of Behavioral Healthcare, Developmental Disabilities & Hospitals