Parity for Effective Addiction and Mental Health Care: Not Just Treatment as Usual

Maia Szalavitz has written a follow-up post on parity. She “educates” by offering what she acknowledges “are extreme examples”. She’s indisputably correct that there is a history of over-diagnosis and over-treatment of addiction. We (Dawn Farm) have talked about this frequently. Addiction treatment providers have been far too quick to blame managed care for their demise and fail to take responsibility for these excesses and for failing to measure outcomes.

However, she’s painting a pretty unbalanced picture. (At least she’s not recycling that 10.5% statistic. 😉 I have several gripes but I’ll limit myself to two. First, some historical context might be helpful. The period she’d reporting on was a characterized by excesses in many areas of health care. Consider the reductions in hospital stays for all conditions and procedures. Consider the reductions in the numbers of hysterectomies and C-sections. How about the changes in prescribing practices with antibiotics. These excesses are what set the stage for managed care. This was not unique to mental health or addiction treatment.

Second, as I pointed out earlier this week, her concerns about those excesses being recreated if parity is passed are unfounded. Where parity has been enacted, insurance companies have implemented tight managed care protocols to limit costs. Parity or no parity, the days of extended hospitalizations payed for by insurance companies are gone.

If anything, I think it’s likely that parity could starve the kinds of programs she’s rightly concerned about. (Although, I must admit that, in 13 years of practice and thousands of clients, I don’t think I’ve ever met a client who was in the kind of boot camp she writes about.) I suspect that people send their kids to boot camps and programs like them at their own cost because their insurance company does not provide adequate care and hospital-based psych units are far too expensive. Parity might create circumstances where parents aren’t so desperate for help (any help) that they send their kids to these programs.