MHARI report details mental health stigma and discrimination

PROVIDENCE – Rhode Islanders struggling with mental health issues often experience discrimination from their health insurance companies and social stigma at work and even hospitals, according to a new report from the Mental Health Association of Rhode Island.

The report, titled “Mental Health Parity in Rhode Island: Experiences of Patients and Professionals,” was presented to members of the Governor’s Council on Behavioral Health last week. It included input from 35 patients and 25 mental health professionals.

Insurance companies continue to institute restrictions, such as the denial of services or the requirement of extensive and repeated proof of necessity for some treatments, the association found.

“Despite the law’s requirement that insurers cover mental health, including addiction treatment, no more restrictively than they do medical and surgical treatment, our findings show that insurers continue to restrict access to care through strategies such as arbitrarily limiting the number of days a patient can see a provider or denying residential treatment, among other strategies,” said Laurie-Marie Pisciotta, executive director of the Mental Health Association of Rhode Island.

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The report calls for an increase in state funding for improvements and expansion to behavioral health systems, and for changing public attitudes about mental health and substance use disorder.

Some patients reported a sense of isolation at work and emergency room visits made more traumatic by treatment from doctors and security, the association found.

Availability and affordability of mental health care is also addressed in the report, which claims there are insufficient networks of mental health providers who are covered by health insurance plans.

Another recommendation suggests that state insurance officials require improvements in reimbursement rates to help incentivize the introduction of services that are not widely available in Rhode Island.

The association also takes aim at utilization reviews, which insurers require of patients and providers to prove the need of a particular treatment. Behavioral health patients can sometimes be directed to complete reviews daily, a frequency that is not seen with physical care, the group says.

“Among the problems with utilization reviews is that while there are numerous nonbehavioral health conditions where coverage is provided to maintain a patient’s condition, oftentimes the standards applied to behavioral health require the patient to show that the service is improving their condition,” Jacqueline Burns of the R.I. Office of the Mental Health Advocate said. “We see many clients whose quality of life improves significantly when they are able to maintain their level of recovery. The behavioral health community generally accepts that effective and optimal treatment can maintain function and prevent deterioration as an important and positive goal in and of itself.”