Already Undercutting Parity?

An article in the Wall Street Journal published on 12-15 under the headline: Workplace Mental-Health Services Expand, Short-Term Counseling Often Cheaper than Therapy Through Medical Plans, should be of interest for those of us who have been advocating for insurance coverage for persons with mental illnesses.
For decades, mental health advocates fought for what is called PARITY inside the insurance industry. What that means is that we wanted insurance companies to treat mental illnesses the same as they did other medical problems.  Most insurance carriers didn’t. They limited how many times a person could see a psychiatrist and they routinely denied medical claims for treatment of such psychological problems as eating disorders.
The National Alliance on Mental Illness and other mental health organizations cheered when Congress finally passed the Wellstone-Domenici Parity Act of 2008 (See http://www.phwa.org/resources/goodcompany/newsletter/article/113)  because it was written to end insurance discrimination that treated mental illnesses differently from other sicknesses.
So what are employers doing now to reduce costs?
According to the WSJ, many are creating EAPs – employee-assistance programs – which are in-house or contracted therapists and psychiatrists. Employee must see these professionals first, in many cases, before they can seek a more extensive and expensive treatment.
While meeting with an in-house therapist may be a satisfactory solution for some persons who may be undergoing temporary problems, David Shern, the president of the Mental Health America and someone I admire, warns that many persons with mental illnesses will be frustrated because they will have to go through a series of EPA workers before they can get the long term help that they may need.
Other advocates worry that someone suffering from depression (the most widespread mental illness) or a severe illness such as Bipolar Disorder or Schizophrenia will be afraid to seek help from an employer’s EPA despite confidentiality assurances. The article claims that 60 to 80 percent of employees who access their company’s EPA don’t end up using additional mental health services in subsequent months, which is good news for employers and insurance companies. But is it good news for persons who need help. Did these employees get the meaningful help that they needed?
While having mental health experts triage cases certainly makes sense, the history of mental health care in this country makes me suspect that EPA’s will become a cheap way to undercut mental health parity.

I hope I am mistaken. I tend to be skeptical by nature.   If you have dealt with an EPA, I’d love to hear your opinion. Meanwhile, I hope MHA and NAMI are keeping an eye on this new development.

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

  • So excited about your new blog. I’m a BIG fan of your book “Crazy”. I’m adding you to my Google Reader as we speak.

  • So excited about your new blog. I’m a BIG fan of your book “Crazy”. I’m adding you to my Google Reader as we speak.

  • Mike Jergens

    I cannot speak for all EAP’s obviously, but I can comment on the one offered by my workplace. There is nothing preventing me or a family member from getting services through the EAP or through a provider of my choice. If I choose to go through the EAP, they have a provision to transition services from the inital five free visits to the coverage offered via the medical plan. My personal experience with my EAP is very positive.

    Like you, I am also skeptical and my EAP may be the exception. Mental illness stigma is alive and well, though perhaps in a diminished sense due to efforts by NAMI, as well as yourself, to better educate people. Your statements regarding avoidance of care due to lack of confidence in an EAP’s statement of confidentiality are quite plausible. Such statements tend to have some sort of ‘weasel wording’ that allow breach due to ‘concerns of safety’ of the client or others with whom the client may associate (usually family). That said, I do not think it is a stretch for perhaps some companies to covertly have their EAP identify ‘risk’ clients under the guise of ‘workplace safety’.

    My advice is for EAP consumers to carefully read all literature for their program before accepting services, compulsory or otherwise. If that is not possible (reading such can be overwhelming), then have a trusted friend read it for you and help you to understand the terms and conditions.

    My $0.02 USD worth…..

    Mike Jergens

    • Elizabeth Flynn

      Congratulations on the new web site; it is awesome, and it is easy to use , even for the technically challenged, like myself. I have already put it in my favorites file.

      I would like to add my 2 cents worth to the article “Already Undercutting Parity”. Pete, I share your skeptism.

      As someone who has been working in psychiatric services for more than 20 years, I can tell you that it has always been about the bottom line for employers…when the insurance companies flat out refused to pay for psychiatric services for people, employers had good cover; “well, we provide the best health insurance we can afford, those services just aren’t covered”….now, that the cover is gone, they are providing “in-house EAP services”, which are designed stringently, to modify the types of services provided . They contract with one provider for “counseling only”…if that doesn’t work or if the employee needs more, well, once again, “we just can’t cover that!”, “a visit to a psychiatrist will need to be handled just like any other medical appointment, subject to co-pays and deductibles.”

      It seems that the newest game for many employers is “how can we creatively, dodge the bullet of paying for expensive mental health services?”

      I hate to sound like a sour old woman! I know there are companies who provide marvelous EAP programs because they know that they are cost effective, in addition to being the right thing to do. The evidence and statistics are there and they are overwhleming. I am happy for Mike Jergens and those who share his experience, however, I am still heartsick at what I am seeing in the field.

      Frequently, when an employee is identified as having major MH issues, there is a waiting game played by some HR Directors; they just wait to build a file thick enough to warrant terminating that employee for “disciplinary reasons.” I resigned exactly three years ago from a large, for profit, medical group, after I had witnessed all I could take. I am embarrassed to admit to you that I watched it for 9 years, before I got brave enough to just quit.

      I am currently employed in a community mental health center which used to treat basically anyone who came in and wanted services, without regard for the level of the services needed. I have been here for three years and have marveled at what we have been able to do with such limited resources. Now, things are beginning to tighten up considerably. With state budgets suffering, with large budget cuts to those providers who had precious little to begin with, we are forced to treat only the sickest of the sick, if they are currently on our roles, ( and already have Medicaid). Otherwise people are out of luck.

      As a society we cannot see the forest for the trees. The costs of doing nothing will prove to be hideously expensive in the long run. I wince when I hear politicians and corporate spokespeople talk about how much concern they have for the mentally ill in our communities. To quote the film industry, “Just follow the money!”

      I’m afraid we all need to stay skeptical and continue to ask the hard questions. Thanks for the opportunity to share.

      Elizabeth Flynn

  • Mike Jergens

    I cannot speak for all EAP’s obviously, but I can comment on the one offered by my workplace. There is nothing preventing me or a family member from getting services through the EAP or through a provider of my choice. If I choose to go through the EAP, they have a provision to transition services from the inital five free visits to the coverage offered via the medical plan. My personal experience with my EAP is very positive.

    Like you, I am also skeptical and my EAP may be the exception. Mental illness stigma is alive and well, though perhaps in a diminished sense due to efforts by NAMI, as well as yourself, to better educate people. Your statements regarding avoidance of care due to lack of confidence in an EAP’s statement of confidentiality are quite plausible. Such statements tend to have some sort of ‘weasel wording’ that allow breach due to ‘concerns of safety’ of the client or others with whom the client may associate (usually family). That said, I do not think it is a stretch for perhaps some companies to covertly have their EAP identify ‘risk’ clients under the guise of ‘workplace safety’.

    My advice is for EAP consumers to carefully read all literature for their program before accepting services, compulsory or otherwise. If that is not possible (reading such can be overwhelming), then have a trusted friend read it for you and help you to understand the terms and conditions.

    My $0.02 USD worth…..

    Mike Jergens

    • Elizabeth Flynn

      Congratulations on the new web site; it is awesome, and it is easy to use , even for the technically challenged, like myself. I have already put it in my favorites file.

      I would like to add my 2 cents worth to the article “Already Undercutting Parity”. Pete, I share your skeptism.

      As someone who has been working in psychiatric services for more than 20 years, I can tell you that it has always been about the bottom line for employers…when the insurance companies flat out refused to pay for psychiatric services for people, employers had good cover; “well, we provide the best health insurance we can afford, those services just aren’t covered”….now, that the cover is gone, they are providing “in-house EAP services”, which are designed stringently, to modify the types of services provided . They contract with one provider for “counseling only”…if that doesn’t work or if the employee needs more, well, once again, “we just can’t cover that!”, “a visit to a psychiatrist will need to be handled just like any other medical appointment, subject to co-pays and deductibles.”

      It seems that the newest game for many employers is “how can we creatively, dodge the bullet of paying for expensive mental health services?”

      I hate to sound like a sour old woman! I know there are companies who provide marvelous EAP programs because they know that they are cost effective, in addition to being the right thing to do. The evidence and statistics are there and they are overwhleming. I am happy for Mike Jergens and those who share his experience, however, I am still heartsick at what I am seeing in the field.

      Frequently, when an employee is identified as having major MH issues, there is a waiting game played by some HR Directors; they just wait to build a file thick enough to warrant terminating that employee for “disciplinary reasons.” I resigned exactly three years ago from a large, for profit, medical group, after I had witnessed all I could take. I am embarrassed to admit to you that I watched it for 9 years, before I got brave enough to just quit.

      I am currently employed in a community mental health center which used to treat basically anyone who came in and wanted services, without regard for the level of the services needed. I have been here for three years and have marveled at what we have been able to do with such limited resources. Now, things are beginning to tighten up considerably. With state budgets suffering, with large budget cuts to those providers who had precious little to begin with, we are forced to treat only the sickest of the sick, if they are currently on our roles, ( and already have Medicaid). Otherwise people are out of luck.

      As a society we cannot see the forest for the trees. The costs of doing nothing will prove to be hideously expensive in the long run. I wince when I hear politicians and corporate spokespeople talk about how much concern they have for the mentally ill in our communities. To quote the film industry, “Just follow the money!”

      I’m afraid we all need to stay skeptical and continue to ask the hard questions. Thanks for the opportunity to share.

      Elizabeth Flynn

  • Erich

    Pete-

    Your skepticism is not unreasonable. Insurance companies very well know and understand the inherent risk an employee takes when admitting to a mental health disease. Especially with Government jobs with any clearance. Despite the stress and rigors of this type of employment, the act of seeing a therapist for anything other than marriage counseling might very well mean risk losing consideration for a job. Until we can look at mental health the same way we look at physical health, we will continue to avoid using services that would qualify patients with a disorder as “incapable” to others, for fear that it can very well affect ones job.

    By the way, nice job on the website. A better feel for the new year!

    All the best,

    Erich

  • Erich

    Pete-

    Your skepticism is not unreasonable. Insurance companies very well know and understand the inherent risk an employee takes when admitting to a mental health disease. Especially with Government jobs with any clearance. Despite the stress and rigors of this type of employment, the act of seeing a therapist for anything other than marriage counseling might very well mean risk losing consideration for a job. Until we can look at mental health the same way we look at physical health, we will continue to avoid using services that would qualify patients with a disorder as “incapable” to others, for fear that it can very well affect ones job.

    By the way, nice job on the website. A better feel for the new year!

    All the best,

    Erich