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Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International

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Publication Date

Summer 2022




Loyola University Chicago School of Law




Despite laws designed to protect mental health and substance use parity in the United States, real parity remains an aspiration. Under the current system, insurance companies use multiple tactics to deny coverage for or delay the provision of mental health and substance use disorder (MH/SUD) treatment. The difficulty of enforcing parity creates a barrier to achieving the goal of accessible behavioral health services. Rather than a continued effort to legislate our way out of this conundrum, it may be useful to look further upstream. Critical impediments to achieving such parity include the basic attitudes and beliefs about mental and behavioral health that underlie the current stagnation in enforcement efforts. A small body of research suggests that a lack of belief in the effectiveness of MH/SUD treatment and negative feelings about people with MH/SUD are correlated with lower support for mental health parity. While more research is needed to fully understand this connection, researchers, advocates, and policymakers should consider using anti-stigma campaigning as a new advocacy tool in the fight for mental health parity.

In Part I, this article examines the parity problem in the United States. Despite recent legislative efforts, the apparent failure to achieve equity suggests that additional statutes are unlikely to propel this country toward parity. Part II examines stigma and false beliefs as an underexplored barrier to parity, further demonstrating the limitations of a regulatory approach. Instead, emerging research illustrates that misunderstandings of mental health and substance use disorders will continue to impede progress toward parity if unaddressed. Finally, Part III looks upstream and suggests anti-stigma work as a necessary intervention to succeed in accomplishing the goals of previous legislative parity efforts.

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