Source: Zhivko Minkov / Unsplash

On the last day of 2024, ProPublica ran an article spotlighting a story that’s all too familiar to those of us working in mental health. A patient at acute risk of suicide began showing modest improvements following intensive outpatient treatment and was subsequently “punished” for it by her insurance company, meaning she received a progress-based claim denial.

Ignoring the pleas of her clinician, the insurer cited that the patient was no longer a danger to herself and could be transitioned to less intensive therapy. Unable to cover the cost of her current treatment, the patient stopped attending her program and experienced a rapid escalation in suicidal thoughts. Within days, she was admitted to an emergency department in a full-blown crisis. Her visit would perpetuate a downward spiral and eventually cost the insurer tens of thousands of dollars, far more than the cost of the treatment she initially requested.

Amid our nation’s anger at insurance companies, we can remember that those suffering from mental health issues—who routinely have non-linear paths to recovery and stability—have faced outsized discrimination by insurance providers, compared to patients with physical health conditions. This injustice has gone so far as to have prompted the enactment of federal legislation like the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) as well as numerous state mandates requiring coverage for mental health and substance use disorder treatment to be “no more restrictive” than coverage for physical health conditions.

Of course, newer and stricter laws haven’t put an end to this discrimination, leading to legal complaints and settlements, through lagging enforcement efforts. Shamefully, many denials of coverage, as well as expirations of program benefits, are 100 percent legal and even standard.

For example, Kendra’s Law— a statute passed in 1999 after a man not taking his medication for schizophrenia pushed Kendra Webdale in front of a subway train—granted New York State courts the power to order people who meet certain criteria to participate in assisted outpatient treatment. While the law served as a model for the nation, its impact has been limited by an adherence to principles similar to those discussed above. Namely, when people achieve stability in assisted outpatient treatment, they are removed from the program. They are penalized, in my opinion, for responding well to treatment.

Of course, New York lawmakers are looking to strengthen mental health laws following a spate of horrific incidents in the subway that mirror the tragedy that took the life of Kendra Webdale. Time will tell if these measures have an impact or—crucially—reflect the insights and experience of clinicians as well as legal professionals working directly in the trenches with those afflicted by serious mental illness and related mental health challenges.

In the meantime, we all need to seek every possible solution to ending the paradigm that has made our current mental healthcare system a mere revolving door, bringing people in and out of acute treatment without taking care of their longer-term needs. Challenging as it might seem, treating serious mental health conditions and substance use disorders is not like treating a cold or infection. People require long-term treatment, supportive housing, and community support, all leading to the need for funding and financial coverage and support. The longer we as a society resist this, the longer vulnerable people will suffer.