Mental Health Parity: the Legal Battle Continues

Monday, March 13, 2023

By Don Sapatkin

---

Our mental health plunged during the pandemic … or did it?

Over the past three years, a drumbeat of studies, news reports and surveys suggested that mental health among the general population was declining during the pandemic. Now a large new study reviewing more than 100 other studies has questioned that widely held assumption. In general, the review found no worsening of people’s overall mental health or their anxiety levels during the first year or so of the pandemic, compared with the year before, and only a slight worsening of depression. For women, general mental health, anxiety and depression declined slightly, while older adults, university students and people who self-identified as gender minority reported small declines in depression symptoms. Overall mental health and anxiety worsened a bit for parents.

A single study’s contrarian findings normally wouldn’t mean much. But there are two reasons why this one, published in the BMJ, could carry more weight:

1) It’s a systematic review and meta-analysis of more than 130 individual studies, which allowed the large Canadian research team to combine datasets originally studied for disparate reasons in order to draw broader conclusions.

2) Unlike the vast majority of previous individual studies and surveys, every one of the 137 studies included in the new review followed a cohort, checking on the same people before and during the pandemic.

The biggest surprise may be the finding that mental health remained stable among young people (with the exception of university students). That conflicts with previous studies that have found big declines among youth, including a review published last week in The Lancet Psychiatry. That review analyzed 42 studies and found that child and adolescent visits to pediatric emergency rooms increased substantially for attempted suicide (up 22%) and suicidal ideation (up 8%) during the pandemic compared with before.  

---

In movies, and life, Black men reluctant to get therapy

The loss of Black lives in recent years from Covid, gun violence and police shootings have scarred the souls of Black people, creating a need for help from professional therapists, writes entertainment journalist Carla Renata. “Yet, in our community, it’s frowned upon, or you are labeled as being crazy,” Renata quotes Van Jones saying during a CNN interview with Jay-Z. “As scared as Black folks are of the cops, we are even more scared of therapists,” Jones added. “We are not trying to go to therapy. It’s a stigma.”

This view is exemplified by characters in two films – “Creed III,” currently in theaters, and the upcoming “Magazine Dreams” – Renata writes in an essay for the film review site RogerEbert.com. In both, Jonathan Majors portrays Black men grappling with mental illness. Magazine Dreams, she says, “boldly illustrates how mental health in the Black community is glaringly ignored and treated like a dirty little secret. A dirty little secret brought on by years of racism, poverty, untreated chronic illness or depression, or even PTSD experienced in something as simple as driving while Black.”

She does see some cinematic hope in two documentaries that discuss the historical effects of slavery on Black men: the 90-minute “HUSH” from 2015 and “I’m Good Bro: Unmasking Black Male Depression” (2019; 55 minutes). If you want to stream them, you may have to do some searching; both can be hard to find.

---

Legal case over mental health parity still going after 9 years

Mental health “parity” – the idea that health insurers should cover mental health care on par with medical care – often feels more aspirational than achievable. Federal enforcement of the laws requiring it is moving slowly, legislation that would strengthen enforcement isn’t moving and remedies ordered by federal courts have been stuck in limbo.

And now, wrangling over a landmark class action lawsuit first filed in 2014 has taken another plodding step with a new motion filed by the plaintiffs last Friday. To recap: The case, Wit v United Behavioral Health, was brought on behalf of thousands of insured patients who were denied coverage for mental health treatments by United Behavioral Health, the nation’s largest health insurer. Three years ago, a federal judge in San Francisco issued a sweeping ruling for the plaintiffs. He ordered United to reprocess more than 60,000 denied claims under the oversight of a court-appointed special master and to use generally accepted standards of care in reevaluating them. Trial testimony showed – and the judge ruled ­– that United used the more restrictive guidelines in order to increase profits. But in March 2022, a three-judge panel reversed his entire ruling.

In January of this year, the three-judge panel vacated its March ruling and issued a new decision that was more nuanced and returned the case to the trial court for new consideration. But as a practical matter, it offers little benefit to the plaintiffs: United doesn’t have to reprocess the claims and is still entitled to use its own guidelines. Two parts of the decision contradict rulings by other circuit courts, and that, plaintiffs argue in their new petition, is a reason the full Ninth Circuit should grant a rehearing. Reuters covered the latest legal developments, and The American Prospect published a broader overview of mental health parity issues and what’s at stake.

---

Ukrainian soldiers’ spreading affliction: traumatic stress

Ukrainian fighters are experiencing intense symptoms of psychological stress, including nightmares, poor sleep, guilt, anxiety and panic attacks after a year of war, troops across the country and psychologists treating them told the Washington Post. Some soldiers are using their own weapons to die by suicide. Others are suffering quietly in hospitals and on military bases, during visits home and on the front lines, where they face a constant threat of Russian attacks even as their symptoms are triggered or worsened by concussions from artillery shelling.

Openly discussing mental health is still taboo in Ukraine, especially for men and more so for soldiers. Few Army psychologists are available anyway. Across the eastern front lines, small numbers of panicked soldiers have abandoned their positions. Some suffering from severe stress said they are reluctant to ask for time to recuperate, knowing that Russia — with a population more than three times that of Ukraine — has more available reinforcements. Even those who have had mental health treatment said they were sent back into combat almost immediately.

---

In other news…

President Biden’s proposed budget for fiscal year 2024 adds billions of dollars for behavioral health according to a review by the American Counseling Association. The funds include: $16.6 billion to expand inpatient and outpatient mental health services for veterans, $578 million to hire more mental health workers, and hundreds of millions to various agencies, including the national 988 lifeline, for suicide prevention, as well as more money for the Department of Education to increase mental health providers in schools. We’ll have more on the budget in the coming days.

Digital mental health startup Cerebral admitted wrongly sharing health data for 3.1 million customers, MedCityNews reported. Cerebral, once phenomenally successful, has been criticized for months for its data privacy practices and has been under federal investigation since last year for allegedly overprescribing ADHD medications.

Anxiety can speed up your heartbeat. Could the opposite also be true? New technologies are finally allowing scientists to test the centuries-old theory that the heart-brain connection goes both ways, according to Medical News Today. The latest evidence supporting the hypothesis that a fast heartbeat can cause anxiety, published in Nature, comes from mice.

“Are women really more mentally ill than men? As a psychologist, I’m not so sure,”

Sanah Ahsan writes in The Guardian. She wonders whether the difference, found in thousands of studies, is due not to chemical imbalances but power imbalances. Women are more likely to experience poverty and sexual and domestic violence, along with the stresses of child-rearing and elder care. “Difficult” women have been given various psychiatric labels throughout history (e.g., “Angry woman syndrome), often for refusing to conform to social roles imposed on them. History’s shadow, Ahsan says in her opinion article, looms over psychiatric systems today.

---

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

---