Kennedy Calls Parity More Than an Insurance Issue

Parity for treatment of mental illness and substance abuse is a human- and civil-rights issue, said former member of Congress Patrick Kennedy during the “Conversations” event with APA President Jeffrey Lieberman, M.D., last month at APA’s Institute on Psychiatric Services in Philadelphia. “Conversations” is an annual event at APA meetings sponsored by the American Psychiatric Foundation in which a well-known person discusses his or her experience with mental illness.

“There is something deeper here that this issue is speaking to,” Kennedy said of the campaign for parity. “That’s why I think there is an opportunity today to carry this cause forward, not simply as a health care issue or an insurance-discrimination issue, but as a human- and civil-rights issue.”

Kennedy and Lieberman spoke for over an hour before a packed hall, and Kennedy, who was instrumental in helping to pass the landmark 2008 parity bill, discussed his journey toward understanding the importance of equal coverage for mental illness and substance abuse. He recounted his mother’s struggle with alcoholism and his own problems with addiction, as well as his Aunt Rosemary’s intellectual disability.

Lieberman opened the discussion by asking Kennedy why—when he might have used his postcongressional career to go into any field or champion any cause—he chose to be an advocate for mental health.

“Mental health chose me,” Kennedy replied. “It was the subject we never talked about in our family, and yet it was ever present in my life growing up. Most people know about my mother’s struggles with alcoholism; she was very public with her struggles in the 70s…. But we never talked about it in our family. It was the elephant in the room. I was aware of stigma, and internalized it growing up.”

He also spoke about the fear and guardedness that pervaded the atmosphere of a family with a famous politician father whose two older brothers had been assassinated. “I remember people carrying firearms all over our house, and people armed with machine guns outside,” Kennedy said. “I remember [my father] putting on bulletproof vests before going out. But we didn’t talk about it. It was something I lived with…but I didn’t know I lived with it.”

So it was with a bemused irony that Kennedy recounted how he championed the landmark parity bill on Capitol Hill. “I could never have foreseen that I would be going through my own travails, suffering from the same illness my mother suffered from, and being a champion on a policy level for equal treatment of that illness. And insofar as I was the champion of parity, [I could never have foreseen] that I would also be a champion against stigma while I myself was parking my car three blocks away from my psychiatrist’s office in Rhode Island.”

Kennedy emphasized that a final rule from the government providing a regulatory framework for implementing the 2008 law—which at press time was expected imminently—will be crucial. He said transparency in the way insurance companies make medical-necessity decisions will be vital to ensuring the full implementation of parity.

“The exciting thing for all of you is that with health care reform, we are rewriting the rules,” Kennedy emphasized. “Organizations like APA need to be even more aggressive than ever before, because we are at a formative point…. This is the moment in history when we really have the opportunity to change the landscape.”

In comments to Psychiatric News commemorating the five-year anniversary of the parity bill, Lieberman had echoed Kennedy’s remarks about the importance of the final rule. “Five years after the passage of the Mental Health Parity and Addiction Equity Act, we have yet to realize the goal of this legislation,” Lieberman said. “While its passage was a historic milestone—much like the Community Mental Health Act legislation in 1963—the promise of the MHPAEA remains unfulfilled and will until the final rule for its implementation is issued and we are assured of its enforcement. We are grateful for these seminal legislative efforts, which like the civil-rights and voting-rights acts have the potential for transformative change in our society, but will not be satisfied until this law becomes our reality.”

After the Conversations event, Lieberman said it had been “a privilege and a pleasure” to discuss mental illness and mental health care with Kennedy. “His comments about his views and personal experience with mental illness, and how it has affected his family, were insightful, inspiring, and refreshing in their candor and sincerity.” ■