The mental health parity gap is John Kiriakou’s description of the distance between what American law promises in mental health provision and what is actually available, set out in July 2025 in the course of arguing against forcible commitment of the homeless.
Law without enforcement
The United States, Kiriakou says, spends “scandalously little money on mental health” — and this despite the fact that mental health parity is written into the Affordable Care Act and is “completely unenforced.”[1]
The measure he offers for the result is a comparison between two kinds of institution. Citing the Rutherford Institute, he says that “in most counties in America, there are more mentally ill people in the county jail than there are in mental hospitals.” The reason is supply: “there just aren’t enough mental hospitals. And the mental hospitals that are there suck ass.”[2]
The sequencing condition
From that Kiriakou takes a rule about order of operations rather than about principle. Forcing people into mental health care, he says, may be done “after mental health care is vastly improved” — and then, twice over, “if at all.”[2]
The two historical limits
He sets the current argument against two earlier corrections that ran the other way. The first is a Supreme Court ruling — beginning, as he places it, under Carter — that people could not be held against their will if they were not a danger to themselves or others; his qualification is that “a lot of them are a danger to themselves or to others and they’re deserving of mental health care.”[3]
The second is California, which “suffered with that for many years, many many years” before changing the law in the 1970s so that the police could no longer forcibly commit anyone. He asks the reader to imagine the alternative: “the cops just ring your doorbell and then by force take you and put you in a mental institution and there’s literally nothing you can do about it.”[4][5]
He is also alert to the private version of the abuse, agreeing that guardianship rackets in which nursing homes take power of attorney over people who are “perfectly fine” and rich are “a real phenomenon”, and that sedation of the elderly to make them compliant is routine — “they did it to my mom. I watched them do it. I knew they were doing it.”[5][6][7]