At a recent legislative breakfast of the Legislative Collaborative of the local mental health association in Rochester, we heard the new mantra for mental health parity. Mental illnesses are real illnesses. They can be reliably diagnosed. They are treatable and treatment is cost effective. Dr. John McIntyre of the Department of Psychiatry and Behavioral Health of the Unity Health System told us that 25 states have parity laws of which 12 were passed this year. Parity is providing health coverage for persons with mental illnesses equal to that for persons with physical illnesses. New York State is not one of them. There is a bill, however, which passed unanimously in the assembly and another on its way through the senate. To underscore the need for parity between mental illness and physical illness, advocates delivered pizzas to legislators with one slice missing with the words "A Piece is Missing."

The good news is that the New York bill is broader than some as to what types of illnesses are covered, who is eligible, and the breadth of coverage. Although there is a commonly held idea that mental health coverage will be expensive, it usually results in about a 1.5% increase in cost which can go as high as 3.25% for most plans. The doctor stressed that treatment for mental illnesses has a higher rate of success treatment for other "physical" disorders because 60 - 80% of major mental health disorders can be treated effectively.

Glenn Gravino of Coordinated Care Services and Stephen Dungan of the Office of Mental Health discussed the Assisted Outpatient Treatment Law called Kendra’s Law. Other articles in this journal have described the Kendra’ s law which targets adults capable of violent behavior who have previously been hospitalized or incarcerated in correctional institutions for mental health reasons and are presently non-compliant with their treatment plan. In order for Kendra’s law to be implemented, it requires a petition to the State Supreme Court, a physician’s affidavit and court hearing which could result in a court ordered plan of treatement for an individual. .

The speakers addressed the burden on Monroe County which must be responsible for the overseeing of the care of persons under the assisted outpatient treatment law. The New York State Office of Mental Health monitors the performance, but the county must receive, initiate and investigate the petition, provide and arrange for services, track compliance and report to the OMH (Office of Mental Health). There is no way to know how many petitions will be involved in the next year, but the estimate is 75-150 annually in Monroe County. This means added liability, legal services, program management, physician’s time and additional mental health services.

However, there was no new money given to the county for this service. The projected costs are $582,000 to $1,124,000 annually. People wanted to know if this would curtail services for other mental health services in the county. The county is concerned about liability to county employees for people placed in treatment involuntarily because there is no exemption for them such as the one for police officers. Beside the fact that the mandate is unfunded, there are strict time lines which will be difficult to keep, such as when a physician must appear in court. There is also the question of different judges handling the cases with diverse results. The speakers felt that the plan in Monroe County can now handle about 30 people at a time. The hope is that people will get treatment without the court order so that planning can be more flexible.

There was little time left for the discussion of mental health managed care and specifically the Special Needs Plan [SNP]. The SNP concept came from a statewide Medicaid managed care movement and results in a collaboration of the Office of Mental Health, the Department of Health and county planning as an option for persons with serious mental illness. Participation is voluntary for the county and client eligibility is based on diagnosis and prior service. It includes outpatient and inpatient care, case management and support services. The payment shifts from "fee-for-service" to "capitation". "Fee-for-service" is a traditional health care payment system under which health care providers receive a payment for each service that they provide. Alternatively, capitation is where a managed care organization is paid a fixed monthly fee for each Medicaid beneficiary enrolled in their plan regardless of whether the beneficiary uses the services. These speakers felt that it would extend Monroe County’s medicaid management care movement, offer opportunity for better outcomes for clients and families, have fair costs, extend the county influence on New York State’s policy and planning and be a managed care "platform" for other populations. However, it is not integrated with basic Medicaid managed care, does not separate children with serious emotional disturbances, does not cover all mental health benefits, serves a limited population, requires extra effort on the part of the Department of Social Services and has extensive reporting requirements. The county is now planning to start participating in about a year.

Before attending this breakfast, I had not been too interested in legislation, the process or details. It became more captivating as I sat in a room with legislators and people working in the field of mental health. I sat at a table with professionals from the Salvation Army and Rochester Psychiatric Hospital. The room was filled with providers, consumers, legislators, and administrators. This audience was receptive to the subject but wondering how to get the word out to others. It is important for big business to endorse legislation supporting mental health parity. I could see how much planning, paperwork and added funds are required when laws such as Kendra’s Law are passed. I could see how sensible it is to have parity for mental health illnesses because they are real, reliably diagnosable, treatable and treatment is cost effective.