Mental Illness Claims Denied: One Family’s Struggle With a Broken System

Mental Health America reports that 20 percent of adults with a mental illness cannot receive the treatment they need*—and at Psych-Appeal, we have frequently found that’s because their claims are denied. Claims denials can be for a number of reasons, ranging from a lack of insurance to limited treatment options. But there’s another barrier—insurers denying treatment unless it’s an acute case.

Sylvia Tawse and Emily Davis’ story is one such example. For six years, they have struggled to access mental health treatment for Emily’s brother. The family has battled with residential treatment centers and argued with their insurer when mental illness claims were denied. The financial burden has been onerous. Sylvia says she and her husband have liquidated approximately $240,000 in assets and may sell their 30-acre farm.

“This is not just about those with a mental illness, our loved ones,” said Sylvia. “This affects the whole ecosystem of a family and our communities, and, I believe, our greater society.”

Sylvia and Emily told their story during a panel discussion with Patrick Kennedy, executive director of The Kennedy Forum, and Psych-Appeal’s Meiram Bendat.

“[Insurers] know that after they grind you down enough you’re going to give up and go home, and pay out of pocket if you can. Or, for many families, they take out a second mortgage,” said Kennedy. “This is a serious, serious issue.”

Bendat agreed, saying the time has come for stricter enforcement of parity for mental health and substance use treatment.

“We rely on regulators, we rely on government, we rely on the enforcement arm of this country to finally put some teeth behind what Patrick worked… to get us,” he said.

You can watch the entire conversation, with an introduction by Kennedy, here.

The panel discussion took place during the Los Angeles County Department of Mental Health’s “Building a Movement for Wellbeing” event on May 6, 2018. Speakers included local, state, and national leaders, among them, Congresswoman Grace Napolitano, Mayor Darrell Steinberg, and Dr. Jonathan E. Sherin. Discussion topics ranged from access to mental health care to criminal justice reform and youth civic engagement.

*Mental Health America, Mental Health In America – Access To Care Data