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Long debates in Congress over mental health parity laws position the most human of health needs up against stretched budgets and market disagreements on treatment value. At the moment, arguments center on insurers' coverage obligations, but few are addressing another debate that is certain to follow.
While many Americans will benefit from richer mental-health coverage, what about extreme cases in which someone needs treatment but refuses? A patient with a severe condition might not seek help on his own. In most states, he cannot be forced legally to accept treatment, no matter how hard family or friends might push for it.
The Virginia Tech gunman who killed 32 people and himself last year repeatedly refused outpatient treatment for his mental-health condition, and no one could do anything about it. By law in Virginia, only those incapacitated by a condition and in immediate physical danger to themselves or others can be placed in treatment. Many believe that is too little, too late.
In 1999, two separate incidents occurred in New York City in which a person diagnosed with a severe mental conditionpushed a subway passenger into the path of an oncoming train. One victim lost both legs, and the other victim, a woman named Kendra Webdale, died.
Kendra's Law, which grants New York judges authority to issue orders for people to take prescribed drugs, undergo treatment or both, came about as a result of those two assaults. It's meant to help family and friends legally intervene.
In the first five years under Kendra's Law, nearly 4,000 people received treatment orders. According to a New York State Office of Mental Health report, among those treated, 87% fewer experienced incarceration, 83% fewer experienced arrest, and 74% fewer experienced homelessness. In addition, there were upwards of 40% reductions in drug or alcohol abuse, harm to others and harm to themselves. Most importantly, those in the program experienced an increase in medication compliance of 103% and a service-engagement increase of 51%.
Mental-health parity has never been addressed on a federal level, nor has court ordered treatment. Since Congress will soonrequire greater coverage responsibility from insurers, expect a call for greater responsibility from public systems that are meant toprotect citizens. Obviously, laws must be fashioned carefully to avoid discrimination and to help those in crisis receive care.
Once mental-health parity laws at the federal level are in the books, and I'm confident they will be, watch for families of those with serious mental disorders to lobby for court-ordered treatment laws. A Virginia woman named Kathy tried for years to encourage her son Joshua to get treatment. He refused, and no one could legally order help for him. He took his own life. Kathy is lobbying for more legislation like Kendra's Law, and I'm certain many other families will be, too.
Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at firstname.lastname@example.org