Tipper Gore: 25 years after the Mental Health Parity Act, we have more work to do

·6 min read

The COVID-19 pandemic has had dramatic effects on the health and wellness of all Americans. Just as disruptive – and more often overlooked – is the effect the pandemic has had on Americans’ mental health.

We are experiencing a national collective trauma on the scale of hundreds of thousands of deaths, widespread illness, lockdowns, significant disruption in employment, and difficulty raising families and caring for loved ones. During this extremely challenging time, people with mental health conditions have faced reduced access to health care providers, in-person counseling and community support networks.

The fight to improve mental health

Improving the state of mental health in America has been my life’s calling. I got to know the parents of a 7-year-old girl with a severe mental illness. The family had used all of their health care insurance coverage, mortgaged their home to provide continued financial support for care, and were eventually faced with granting custody of their daughter to the state in order to continue her treatment.

On the other hand, I had health insurance coverage when my young child was critically injured in an accident. These parents were facing an awful choice, and the stark contrast hit home with me. I organized a group that would become known as Tennessee Voices for Children to provide mental health support to children and families. In the past fiscal year, TVC has reached over 50,000 families, caregivers and professionals.

Mental health teleconference on April 22, 2020, in Fayetteville, N.C.
Mental health teleconference on April 22, 2020, in Fayetteville, N.C.

No parent should ever have to make this decision. No child should have to be ripped away from their family’s care to have a chance at getting better.

On Oct. 10, we marked World Mental Health Day. This is an important opportunity for us to redouble our commitment to mental health awareness and treatment.

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According to the National Alliance on Mental Illness, approximately 1 in 5 Americans have a mental health condition, but only half of these people receive the treatment they need.

I’ve seen the power of good mental health support. From the Vietnam War veteran who went from years of living on the streets to having the security and dignity of a home to a woman I met outside the gates of the White House who went from abject poverty to a stable career, mental health care made the difference.

Over the past several decades, we have made significant progress in supporting the full health and wellness of Americans – physical and mental – but there is more to be done.

Legislation fights for mental health

Sept. 26 marked the 25th anniversary of President Bill Clinton signing the bipartisan Mental Health Parity Act into law. Before 1996, health insurance companies as a matter of practice would cover mental health treatment differently – and less generously – than they would cover other medical conditions.

Americans who were fortunate enough to have coverage for mental health conditions would routinely face yearly and lifetime caps on that coverage. In the middle of a mental health crisis, if they hit that cap, they’d suddenly be without coverage and without treatment.

The Mental Health Parity Act took the first steps to rectifying this inequity, and helping more Americans get coverage and treatment for mental health conditions. For large public and private employer coverage, the law stated that insurance plans needed to cover medical/surgical care and mental health care equally when it came to the amount of coverage they would pay out each year and over the lifetime of the policy.

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The 1996 law provided the first protections for people with mental health conditions – protections that we have built on in the years that followed. Three years later, the Clinton-Gore administration expanded mental health coverage for all federal employees, achieving full parity of coverage. In 2008, the bipartisan Mental Health Parity and Addiction Equity Act was enacted, strengthening the protections in the 1996 law and extending them to coverage for substance use disorders and addiction.

The Affordable Care Act made more progress in expanding coverage to people with mental health conditions. In addition to expanding health coverage to tens of millions of Americans, the consumer protections in the ACA applied mental health parity regulations to insurance sold to small businesses and individuals. Mental health and substance use disorder treatment are covered under essential health benefits, and insurers can no longer deny coverage or charge people more because of preexisting conditions, including mental health conditions.

Inequities in mental health treatment

It has been 2 1/2 decades since we took this first critical step to codify mental health parity into law. However, gaps in the way we treat Americans with mental health conditions remain – and we have more work to do.

First and foremost, we need to guarantee that all Americans have access to quality, affordable health coverage. We need to expand the guarantees and protections in the ACA, which has helped so many Americans with mental health conditions to purchase coverage and get treatment. We must fight efforts to weaken and undermine the ACA and find ways to build on the consumer protections for those struggling with mental health conditions. And we must directly confront enduring racial disparities in health outcomes and embed racial equity throughout health reform efforts.

Tipper Gore and President Bill Clinton at the White House Conference on Mental Health in 1999.
Tipper Gore and President Bill Clinton at the White House Conference on Mental Health in 1999.

Second, we need to focus on the role of mental health as we reform our criminal justice system. People with mental health conditions are dramatically overrepresented in the criminal justice system – and once incarcerated, these Americans are routinely denied access to the mental health treatment that they need. Unfortunately, this reality includes children.

As part of broader criminal justice reform, we need to ensure that our justice system treats mental health conditions as a medical problem and fights these issues with treatment and not incarceration.

Finally, we need to ensure that we adequately support community-based organizations, which are on the front lines of providing support to individuals with mental health conditions, and often the most trusted by traditionally excluded and marginalized communities.

Government support of these organizations, including those that provide treatment for substance use disorders, is a good investment. One of the best ways we can do this is by expanding the Certified Community Behavioral Health Clinic program, which operates now in 40 states and has provided critical help to low-income Americans with mental health conditions.

Mental health care is health care, plain and simple. Since President Clinton signed the Mental Health Parity Act into law 25 years ago, we have made significant progress. As we celebrate this anniversary, and mark World Mental Health Day, we must reflect on how far we’ve come, but also commit to closing the gaps that remain.

Tipper Gore was the second lady of the United States from 1993-2001. She is a nationally recognized author and social issues leader who has advocated for mental health awareness and benefits throughout her career.

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This article originally appeared on USA TODAY: Mental health care has improved, but our job is not done: Tipper Gore