Navigating Legal Barriers to Mental Health Services

/ Blog Post

By Deborah Steinberg, 2018 Equal Justice Works Fellow sponsored by Fidelity Investments and Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

Photo of Deborah Steinberg
Photo of Deborah Steinberg

More than half of adults in Massachusetts who seek access to mental health care face difficulties getting the treatment they need. They cannot get appointments within a reasonable timeframe; cannot find providers who are accepting new patients; and cannot access providers who accept their insurance, especially when they are on Medicaid. Many others try to access services, only to be told by their insurance that the treatment is not medically necessary and will not be covered, and therefore it becomes unaffordable. Among those who do try to access mental health or substance use disorder services, almost 40 percent are unable to obtain care because of these barriers, and more than 12 percent end up in the emergency department. It takes so much strength and motivation for people in pain to overcome the personal hurdles and social stigma to seek out mental health treatment. No one deserves to face additional legal barriers to healthcare.

I grew up in a suburb of Boston, struggling with mental health challenges. I was acutely aware of how many of my friends and peers were suffering as well, all in relative silence. After a wave of suicides in my town, I started volunteering with a suicide prevention helpline. The people who called inspired me with their courage and resiliency, and I knew that more could be done to help these individuals before they reached this level of crisis. I became involved with town-wide coalition efforts to prevent suicide, and I continued advocating for improved access to mental health care with state and national legislative efforts through the American Foundation for Suicide Prevention. To this day, I still volunteer for the Crisis Text Line, because I know how valuable and meaningful this service is for those with nowhere else to turn.

When I returned to Massachusetts after college to work in the Office of Patient Protection, I began to realize how these barriers to care were not only deeply entrenched in our systems and institutions, but also the law. While there are state and federal mental health parity laws that require health insurance plans to offer comparable mental health benefits like medical/surgical benefits, these laws are vague and not effectively enforced. There are also regulations that guarantee individuals enrolled in Medicaid have timely access to providers within their networks, but few people are aware of these rights or how to use them. Furthermore, when people are denied services by their insurance, they have the right to appeal those decisions, but these appeals are nearly impossible to navigate without an attorney. My Equal Justice Works Fellowship project combines direct representation, community outreach, and public policy advocacy to make mental health parity a reality in Massachusetts, and to eradicate the barriers that make this care inaccessible to low-income residents.

Deborah Steinberg tabling for her host organization, Health Law Advocates

Most often, I help clients access mental health care through the appeals process when their insurance denies coverage of a service. I have secured coverage of psychiatric hospitalizations, residential treatment for eating disorders, ambulance rides, and a range of other services for my clients. Most of these services, if provided for a medical/surgical condition like cancer or a heart attack, would never be questioned or denied in the first place. Because of the denials, these individuals and their providers must jump through excessive and unnecessary hoops—proving to the insurance companies that the treatment is necessary—to access the service to which they have a legal right as recipients of Medicaid.

One of my first clients was seeking access to out-of-state residential treatment for an eating disorder. She had already tried every other level of treatment, and no in-state facility would accept her as a patient because her condition was so acute and only getting worse. Nonetheless, her insurance denied the request, claiming that this treatment was not a covered benefit. By relying on state and federal mental health parity laws, we successfully got the administrative law judge to order her insurance to pay for the treatment, and she was able to start treatment the following week.

Recently, I also worked with a woman with schizoaffective disorder, compounded by multiple other mental and physical diagnoses, for which she takes at least six medications. Due to a history of lethal suicide attempts, her medication was kept locked in a box. Since the box was secured, a nurse had to come to her home every morning to assist her with the medication. Medicaid reduced this service, so the nurse could only come twice a week. As a result, my client had multiple days where she did not take her medications and experienced added mental distress. Again, if the client had a physical disability that required this service, it would not have received this level of scrutiny and she would not have needed to go without care for so long. The case went to a hearing before the Medicaid Board of Hearings, and we were able to get Medicaid to agree to reinstate the essential service.

Mental illness is real, and recovery is possible with the appropriate supports and services. What gives me hope is that so many people who are struggling, and their families, are willing and motivated to seek the treatment they need. I am grateful to Equal Justice Works, Fidelity Investments, and Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. for the opportunity to devote my career to helping these people and removing the legal barriers that prevent them from accessing affordable and comprehensive mental health care.

To learn more about Deborah’s Fellowship, visit her profile.

What gives me hope is that so many people who are struggling, and their families, are willing and motivated to seek the treatment they need.

Deborah Steinberg /
Equal Justice Works Fellow

Learn more about becoming an Equal Justice Works Fellow