by Drs. Donald Ross and Mark Levy

The economic burden of mental disorders rivals that of cardiovascular diseases and exceeds the costs of cancer, chronic respiratory diseases, and diabetes. Mental health conditions cost the U.S. economy an estimated $47.6 billion annually in lost productivity due to unplanned absences, with total costs reaching $282 billion each year. Meanwhile, suicide is the second leading cause of death among individuals aged 10-14 and 25-34 and the third leading cause among those aged 15-24.

Yet, despite these alarming statistics, true mental health parity remains an illusion.

Decades of Unfulfilled Promises
More than 60 years ago, in 1961, President Kennedy called for mental health parity in the Federal Employee Health Benefit Program. Congress took another 35 years to pass the Mental Health Parity Act, and even then, true parity remained elusive. In 2008, lawmakers attempted to strengthen protections with the Mental Health Parity and Addiction Equity Act.

Yet, since then, suicides have increased by 30%, and drug overdose deaths have quadrupled (until a recent slight decline). What went wrong? While the opioid epidemic, the rise of synthetic opioids, and the loneliness crisis—exacerbated by COVID-19 and arguably social media—play a role, our so-called “health care system” is uniquely culpable.

The Systemic Sabotage of Mental Health Care
Despite the law’s intent, insurers have systematically undermined mental health care:

  • Higher out-of-pocket costs: Patients often face higher copays for mental health visits than for other types of care.
  • Restricted access: Prior authorization hurdles and inadequate provider networks make mental health care difficult to obtain.
  • Insufficient coverage: Limits on the number of visits prevent adequate treatment.
  • Underpayment of providers: Low reimbursement rates have worsened the shortage of mental health professionals in-network and out-of-network.

Consider This!
The 2025 Medicare reimbursement rate for a 60-minute mental health counseling visit is just $154.29. Medicaid pays only 81% of this rate. Meanwhile, the Congressional Budget Office found that commercial and Medicare Advantage plans reimburse mental health providers 13-14% less than Medicare fee-for-service rates—while paying 12% more for other specialties. On average, office visits with medical/surgical clinicians receive 22% higher reimbursement than those for behavioral health.

A Broken System with Devastating Consequences
Given these economic realities, is it any surprise that:

  • Nearly half of Washington state counties have zero psychiatrists or psychologists.
  • Washington ranks 49th out of 50 states for inpatient psychiatric beds.
  • As recently as 2022, the average wait time for a psychiatric appointment in Seattle was 73 days.

How Do We Fix This?
This crisis will not fix itself. Change must start with us. We must demand that insurers treat mental health care with the same urgency and equity as physical health care.

  1. Demand accountability from insurers. Insurers should not be allowed to underpay mental health professionals or impose arbitrary barriers to care. Contact Washington’s Insurance Commissioner and demand enforcement of parity laws.
  2. Push for policy changes. We need legislation that mandates fair reimbursement rates for mental health care—at the state and national levels. Get involved in advocacy efforts and support mental health reform bills.
  3. Expand access to care. More funding for inpatient psychiatric beds, community mental health programs, and mental health professional training is critical. Urge policymakers to invest in these resources.
  4. Speak up. Stigma still prevents people from seeking care. We must change the conversation around mental health and demand that it is treated with the same urgency as physical health.
  5. Join the movement. Physicians, healthcare professionals, and patients must unite to ensure mental health care is not just an afterthought but a priority. Support organizations working toward mental health parity, participate in advocacy efforts and push for change in your networks.

Mental health is not a luxury. It is not optional. It is essential.
At KCMS, we are acting. Our Delegate Council convenes on May 21st, providing physicians with a platform to advocate for meaningful policy changes at the state and national levels. Join us at KCMS today to be part of the fight for true mental health parity—because together, we can demand the changes our patients and communities deserve.