DEPRESSION, SUICIDE, DISCRIMINATION AND PARITY

Depression, Suicide, Discrimination and Parity

By Andrew Malekoff© Summer, 2018

In the immediate aftermath of the suicides of Kate Spade and Anthony Bourdain Gov. Cuomo issued a press release about new funding to address the rising rate of suicide.

He stated: "Two high-profile suicides this week put mental illness front and center, but while those names were the ones in the press, every day there are thousands of New Yorkers who struggle with suicidal thoughts, and we must do everything we can to support them. Depression does not discriminate. It affects every part of society and people from all walks of life."

I applaud the Governor for bringing this matter to light. He stated, “Depression does not discriminate.” Nevertheless, health insurers that do not comply with federal parity law, denying timely access to care, do discriminate. When New York State government does not enforce this law, they aid and abet discrimination against the “thousands of New Yorkers,” who the Governor referred to as those “who struggle with suicidal thoughts”.

The difficulty people have accessing mental health and addiction care is not simply a matter of stigma. It is a matter of discrimination. This is a civil rights issue that an announcement of new funding alone will not solve.

On December 15, 2017, North Shore Child and Family Guidance Center held a press conference at its headquarters in Roslyn Heights and issued the results of a research study – Project Access that we conducted in collaboration with LIU Post Department of Social Work. 

In this year-long study, hundreds of Long Islanders were surveyed about their experiences attempting to obtain help for mental health and addiction problems.

Of the 650 Long Islanders who took part in the survey, almost half said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, nearly 40 percent said that their insurance company did not have an adequate number of providers and two-thirds said that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.

NY State Senator Todd Kaminsky, who attended the December 15th press conference, stated that the findings were “Damning.”

In a bipartisan effort, Kaminsky and Senator Elaine Phillips wrote to the Department of Financial Services (DFS) on January 9, 2018 citing the Project Access study and requesting “a thorough investigation to determine why insurance companies are not being held accountable for network adequacy.” Network adequacy is the part of the federal parity law that states that health insurers who cover mental health and addiction care must have an adequate number of providers in their network. Many more people wrote directly to Gov. Cuomo, requesting the same.

Almost five months later Scott Fischer, Executive Deputy Superintendent for Insurance, a division of DFS, responded in writing to the Senators. Fischer wrote: “DFS’s review of the various networks has confirmed that each of the insurance companies in Long Island exceeds the standards for mental health and substance use providers, for the purpose of the commercial products sold outside of NYSOH.”

Translation: There is no problem. There is nothing more to do. This does not square with the results of Project Access.

Health insurers and government ignoring federal parity law is discrimination. When it comes to suicide prevention: access delayed, is access denied.

Discrimination deserves a place alongside stigma when the conversation turns to access to care.

It’s a matter of civil rights.

Long after the tragic deaths of Kate Spade and Anthony Bourdain fade from the front pages, the lack of compliance and enforcement of federal parity law will persist and the thousands of people that the Governor spoke of in hispress release will still be unable to access care.

Published in the New York State Behavioral Health News, Summer 2018 issue

NATALIE CIAPPA'S LAW

Natalie Ciappa’s Law

By Andrew Malekoff©

One month ago the Nassau County legislature passed a bill that requires police to notify school districts about heroin arrests. The bill, Natalie Ciappa’s Law, is named after a teenaged girl from Long Island, who died of a heroin overdose in June, 2008.

My heart goes out to Natalie’s family and to the growing number of families on Long Island that grieve the loss of their children to heroin and other addictions. Having worked in the addictions field for over three decades there are a few simple truths that I have learned. One is that drug addiction is a disease that destroys families. Another is that it doesn’t have to.

A Disease Suffered Secretly

Those that are afflicted with heroin addiction and their families have been stigmatized by an unforgiving society that view it not as an illness but as the consequence of a moral failing, lack of will power or poor parenting. Although progress has been made in dispelling such damaging myths, I am afraid that we still have a very long way to go.

Most people with physical illnesses are the beneficiaries of widespread understanding, sympathy and support. Not so with addiction. Can you imagine for a moment lecturing a parent whose child is diagnosed with brain cancer and telling them that if they had enforced an earlier curfew that the cancer could have been prevented. Such is the twisted logic of the self righteous and ignorant who refuse to accept that addiction is a disease that does not discriminate by race, faith, upbringing or privilege.

The stigma of addiction necessitates that it is most often suffered secretly, only deepening the pain for all that care for an addicted child. Public support must replace secret pain; and therein lies the challenge in Natalie Ciappa’s Law. With this law comes enormous responsibility. School officials will no longer be able to keep a straight face and say, “There is no drug problem in my school district.”

A Call to Action

Will the passing of this law bring with it dialogue and collaboration among stakeholders that will ensure that notification of arrest information will cause no further damage to suffering families? Will the passing of this law protect and prevent others from criminal activity, and also help young people and families to find and get the help that they need?
The answer to these questions is: It depends. It depends what school district leadership does with it. I assure you that it will not be easy. But nothing worth fighting for ever is.

Natalie’s Ciappa’s Law will shake things up and create dilemmas and concerns among school officials, family members and others. Sometimes it is worth the risk to shake things up in order to make a difference.

Beyond notification, I hope that the law that bears her name will do two things. First, I hope that it will serve to remind all parents that Natalie was not a bad girl. She was a beautiful young woman who suffered from an insidious and progressive disease. In addition to the good that it can do, passing this law is a step towards publicly restoring Natalie’s good name and the dignity that she deserves in death. Second, I hope that the New York State Office of Alcoholism and Substance Abuse Services (OASAS) will provide adequate funding and strong leadership for drug and alcohol treatment for teenagers and their families.

Natalie’s Legacy

Finally, although there are those that believe strongly that this new law is flawed, either because it does not go far enough to expose other illegal drug activity or because it goes too far in exposing vulnerable individuals, it is my hope that Natalie Ciappa’s Law will be a step forward in the ongoing march to ensure that all our children are healthy and safe.

Originally published in the Anton Newspaper chain, Long Island, NY in January 2009.