Mental health care parity without proper enforcement is about as effective as  speed limits would be without adequate policing. And while it would be nice to think that the existence of a law would mean compliance, that is as naïve as thinking that people always follow the speed limit because it’s the law (and it has nothing to do with the fear of those flashing lights in the rear view mirror).

As we discussed in our article on Mental Health Care Parity, there are a number of reasons why parity laws are falling short of their goal (not the least of which is adequate access which we discussed in more detail in Barriers to Mental Health Services).  Given that enforcement is essential to compliance, whether we’re talking about speed limits or parity, it’s safe to say that lack of enforcement may very well be one of the main reasons why mental health parity has a long way to go.

The American Psychological Association (APA) has called on congress to pass the Parity Enforcement Act of 2021 (H.R. 1364) in order to strengthen the Department of Labor’s authority to enforce the parity law and also to increase funding to support greater oversight and enforcement. While many states have taken up the issue of enforcement in order to strengthen parity laws, H.R. 1364 would address it on a national level.

So what’s wrong with enforcement now? Essentially it’s a reactive process that relies on consumer complaints. First of all, how likely is it that a complainant would have the information and ability to identify a violation? It’s safe to assume that the average person probably isn’t even aware of parity laws, nor would they know where to begin if they thought their insurer wasn’t in compliance. It’s even possible that an individual would fear losing their insurance coverage altogether if they decided to take on their insurance company. And for someone seeking mental health assistance, the last thing they will want to do is add more stress to their lives by pursuing a parity law complaint.

Being reactive isn’t quite as good as being proactive, but is the process really that much of a challenge? “One treatment provider described her state’s complaints process as “a system designed to want to make people give up,” a description not unique to that state.” [1] Sounds like quite an obstacle indeed.

If lawmakers truly want to address mental health care parity, then enforcement of the law needs to be addressed. After all, if public health concerns from motorists driving too fast is such an issue that policing it is a forgone conclusion, we should expect no less from lawmakers than being proactive in their approach to enforcing of parity laws. Given the events of the past year, the need for access to mental health services has never been more critical. According to Stress in AmericaTM 2020: A National Mental Health Crisis, conducted by The Harris Poll, “the majority of adults (61%) say they could have used more emotional support than they received over the prior 12 months, with more than 8 in 10 Gen Z adults (82%) saying the same.” [2] We’ve waited long enough for real change; the time to act is now.


[1] https://www.healthaffairs.org/do/10.1377/hblog20181009.356245/full/

[2] https://www.apa.org/news/press/releases/2020/10/stress-mental-health-crisis

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