Dueling Opinions: What’s challenging access to mental health services?

Nearly 53 million adults ages 18 and older in 2020 suffered from some type of mental illness in the previous year, federal data shows. The COVID-19 pandemic has only exacerbated the situation.

Where you think the industry stands as far as mental health parity—compliance with the Mental Health Parity Act and subsequent legislation?

Shawn Coughlin:Let me start by saying we have not gotten anywhere close to recognizing the vision of parity. We continue to battle some of the same issues that led to the parity fight in the first place. And that is denial of claims, overly aggressive use of utilization management techniques, all sorts of issues that we started this process on. …There have been some improvements. Some plans are better than others. But it’s only recently frankly.

Indira Paharia: I think as payers we’ve made a concerted effort on parity compliance. Of course there’s still a lot of work to do. … The essence of the law is ensuring fair and equal access to mental health and substance use disorder treatment, which is undeniably critical to achieving something like integrated care. No one will argue about the importance and value of the law, but the challenge is in the interpretation and the details of how we demonstrate compliance.

What are some other systemic issues that have been long-term challenges for mental healthcare access?

Coughlin: No. 1 has been workforce, workforce, workforce. We compete against the physical care side, the acute-care side of med-surg hospitals and others. And because we have historically been under-reimbursed across the board, whether it’s Medicare, Medicaid, commercial, you name it, our folks are at a disadvantage in competing for talent. … And of course the workforce shortages have been exacerbated by the pandemic.

Paharia:We’re seeing demand for behavioral health services going up, but there is lack of capacity. So wait lists are increasing, meaning that individuals aren’t getting timely access to needed treatment. Behavioral health organizations are having trouble recruiting and retaining employees. Some of the recruiting challenges are just the applicant pool, and the retention challenges have to do with significant provider burnout.

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Given the pandemic and all the focus it’s placed on mental health, what are you most optimistic about right now?

Coughlin: The pandemic exposed the shortcomings, the holes and the breaks in the behavioral health system and network. … I think Congress is starting to recognize that you can’t keep doing the same thing over and over again if you don’t get better outcomes. … Both the House and Senate are currently engaged in comprehensive structural reviews regarding mental health, more so in the Senate.

Paharia: Not that you ever want to think there’s a silver lining to something like a pandemic, but one good thing is that it’s really shined a spotlight on behavioral health, which has helped reduce stigma. … It’s also exciting to see state and federal governments trying to solve problems like the behavioral health workforce, and how do we get more people into treatment.