Dr. Drew Pinsky, an internist, addiction medicine specialist and media personality, spoke to county officials July 22 about the importance of psychiatry and mental health parity alongside Los Angeles County Supervisor Kathryn Barger at the NACo Annual Conference General Session.

“It’s odd that we in this country treat illnesses in the cranium different than every other organ in the body — our lungs get sick, our brains get sick,” Pinsky said. “… We’re allowing people to die in the streets. It is a level of insanity; I don’t understand it. As somebody who worked in a psychiatric hospital for decades, it’s not that hard to treat. We know how to do this. We just need the resources, we need the beds, we need the psychiatrists.”

Pinsky applauded the federal priorities of NACo’s Mental Health Commission, of which Barger is a co-chair. “I support everything in that proposal,” he said.

“They’re excellent. My lungs could fill with air reading them,” he noted, before adding that parity and investing in psychiatric care are crucial in alleviating the nation’s mental health crisis.

“We have armies of social workers, we have a lot of good psychologists, a lot of good chemical dependency workers, but not enough doctors,” Pinsky said. “And the physician must be at the head of these teams. These are medical disorders that require medical assessments, medical intervention, medical planning … Asking mental health workers, chemical dependency counselors, social workers to do the work of physicians, it is literally the same thing as taking a team of physical therapists and making them do orthopedic surgery.

“They are not trained to do that, and they are not in a position to intervene medically on these brain diseases,” Pinksy said. “They are extremely important and they are extremely skilled, but if you leave out the doctors and the nurses, you are literally running open-air hospitals without doctors and nurses in our county [Los Angeles], where seven patients are dying a day.”

Despite the Mental Health Parity and Addiction Equity Act, there’s still progress to be made in parity, he said.

“When the resource management comes down on you, whether it’s the insurance reviewer or the Medicaid review or Medicare is running out or whatever,” Pinsky said, “on the medical side, if the insurance company wants to know how long this person is going to be in the hospital, I go, ‘Hey, they had surgery on Tuesday, they still need nursing wound care, they need three more days of antibiotics and then we’ll see.’ Case closed; they don’t argue with me.

“In psychiatry, when I ask for an extra day, they fight. ‘What’s the criteria? How do you do that?’ If you leave the criteria for parity to the resource provider, there will be no parity … So, for parity to work, one thing must be in place, which is that when doctors can defend his or her decision and it is their opinion that the patient is to stay in the hospital, they stay in the damn hospital, and that’s it.”

Pinsky said medical-assisted treatment is a “giant leap forward” and is something that gives him hope about the advancements of improving mental health in the United States.

“There are street teams in our county that are starting, medical physician squads that are going out and they’re starting to prescribe,” Pinsky said. “Also, long-acting anti-psychotics — they’re expensive, they have to be funded. That is the missing piece. We have to have the ability to administer them when somebody’s anosognosia [when someone rejects a diagnosis of mental illness] is such that they cannot participate with us in the treatment.

“We have to have the ability to do that, much the way we do with the brain disorder we call dementia. That’s the only one we’re allowed to do that with, and yet that’s a disease that is progressive no matter what we do; it’s inexorable. And yet, something like schizophrenia, if we intervene early, we can massively change the course of the illness.”