Those with mental health and addiction challenges face enormous obstacles to care | The Kennedy Forum

Those with mental health and addiction challenges face enormous obstacles to care
July 6, 2020

By Meiram Bendat

COVID-19, mass unemployment and the increasingly visible mistreatment of Black Americans by police have opened a window on profound and longstanding inequities in the US as never before – and one result is a rising wave of mental and emotional distress.

Nearly four in ten Californians are now showing signs of clinical anxiety or depression, or both – and members of the Black and Latino communities are yet again at greater risk as economic dislocation, isolation, trauma, anxiety, and grief take a grim toll.

Data from a recent study shows the state could suffer over 22,500 additional deaths of despair—suicides, overdoses, alcohol poisoning, or liver disease caused by alcohol—because of the COVID-19 pandemic. Past research has shown that for each one percentage point increase in unemployment, suicide rates can increase between 1% and 1.6%. Since mid-March, 4.5 million Californians have filed for unemployment—the most in the nation.

But our disjointed, pay-out-of-pocket behavioral health care system is woefully unprepared to handle a surge in demand. As a psychotherapist in California, I’ve seen it firsthand.

A critical part of the problem is that our nation’s health insurance system fails to cover needed mental health services, including treatment for trauma and addiction. Insurers focus on crisis care rather than preventative care, reimburse at rates so low that few providers want to join networks or even enter the field, and don’t cover treatment for mental health and substance use disorders the same way they cover medical/surgical treatment.  

Time and again, insurers’ coverage denials mean that mental health and addiction treatment is available only to the affluent who can afford to pay out-of-pocket, with everyone else out of luck.

To address this systemic issue, which has contributed to historic rates of overdoses and suicides in our country, not to mention a decrease in U.S. life expectancy, I began to help people file appeals with their health plans. Sometimes those appeals lead to lawsuits—all in an attempt to get coverage that was wrongfully denied.  

Very quickly, I pinpointed a common thread in my cases: health plans covering only limited care to reduce short-term symptoms, while refusing to cover treatment for patients’ underlying mental health and addiction conditions. The denied care was justified as “not medically necessary,” using deeply flawed clinical coverage criteria developed or purchased by insurers.

Take for example the class action, Wit v. United Behavioral Health (UBH), which I initiated on behalf of more than 50,000 people against the nation’s largest insurer. In a landmark 2019 decision, a federal court in San Francisco ruled that UBH’s internally developed criteria were inconsistent with generally accepted standards of behavioral health care and wrongly influenced by a desire to cut costs.

Specifically, the court found that UBH’s review criteria were skewed to cover “acute” treatment, which is short-term or crisis-focused, and disregarded chronic or complex mental health conditions that often require ongoing care. Sadly, these practices are not limited to UBH, which is why I’ve since helped bring more cases against other insurers across the nation.

The Wit case exposed how insurers get around existing rules to deny needed care. Thankfully, California now has the opportunity to put an end to such practices once and for all.

Senator Scott Wiener has authored legislation that would require insurers to make coverage determinations using generally recognized standards of care and would expand existing laws to cover all mental health and substance use disorders—not just a select few.

In addition to helping Californians access care, requiring insurers to follow these standards will reduce the enormous costs to Medi-Cal and other public programs associated with untreated mental health and substance use disorders, which can sometimes lead to homelessness or disability. Consider that for every $1 spent on substance use treatment, there is approximately $7 in monetary benefits to society.

Focusing on the prevention, early intervention, and addressing underlying mental health and substance use disorders is key to advancing California’s COVID-19 recovery. We must eliminate roadblocks to care, especially during a time when we know people are struggling. With time running out on a shortened session, it is critical that Senator Wiener’s effort moves forward. If it stalls, mental health and addiction will once again move to the back burner.

We can’t wait any longer. Lives are at stake. It’s time for state leaders to get ahead of the curve.

Meiram Bendat, J.D., Ph.D. is a California psychotherapist, attorney, and founder of Psych Appeal, the first private law firm in the U.S. exclusively specializing in mental health insurance advocacy on behalf of patients and providers.

Learn more about SB 855 here