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Making mental health parity a priority

Protecting benefits whether for a sprained ankle or for opioid use

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U.S. Labor Secretary Marty Walsh. (Photo public domain)

Mental health is health – period.

When someone gets the flu, or sprains an ankle, there’s no question about whether care is needed. If that person has health insurance, they can go to their doctor, or nearest urgent care or hospital. It’s often a commonplace, run-of-the-mill experience. You go in, you pay a copayment, you see the health care professional, and you’re on your way home.

Unfortunately, the experience for someone with a mental health condition or in need of treatment for substance use disorder is usually very different. Often, people feel apprehensive about seeking treatment in the first place. They think, “What will my friends think?” or “I probably shouldn’t tell my job that I need time off to see a psychologist.” Trust me: I had similar thoughts when I needed help dealing with alcoholism in my twenties. I knew something was wrong, but it was so hard to take that first step. I’m so grateful that as a union member I had access to the care I needed, because once I did ask for help, my life started to change for the better.

But for many, once they reach a point where they’re ready to seek care, getting care can be an even bigger challenge. From identifying professionals who will take your insurance to figuring out what requirements you need to meet for treatment to be covered by your plan, the process can be incredibly difficult to navigate. Not only is this frustrating for those who need critical services — in many cases, it’s illegal.

The Mental Health Parity and Addiction Equity Act, passed in 2008 aims to improve access to treatment for mental health conditions and substance use disorders. At its core, the law is designed to make sure insurance companies and health plans cover mental health and substance use disorder benefits the same way they cover physical benefits. Whether you’re seeking care for a sprained ankle or for opioid use, your benefits are protected by the law.

And with more adults seeking care for mental illness and substance use disorders following the pandemic, ensuring that everyone gets the care they deserve is more important than ever. Receiving the care that you need, and are entitled to, shouldn’t be a struggle.

That’s why I’m working with our Employee Benefits Security Administration to prioritize action to ensure equal access to treatment for mental health conditions and substance use disorders for more than 136.5 million people and to remove the stigma for seeking help in the first place. This is a priority for the Biden-Harris administration, for the department, and for me personally.

Last week, we released a report to Congress that highlights where insurance companies and health plans are falling short when it comes to providing parity in care, and how we’re ramping up our enforcement of the law. We hope this report and our ongoing efforts show health plans that we take this issue seriously — and provide more opportunities for people to get the care they deserve under the law.

Marty Walsh is the U.S. Secretary of Labor. Follow him on Twitter and Instagram at @SecMartyWalsh.

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Commentary

Disillusioned about democracy? Think of it as a community garden

May 17 is the International Day Against Homophobia, Transphobia, and Biphobia

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Julia Ehrt (Photo by Ben Buckland for ILGA World)

A short walk from where I live, there is a community garden. People of all ages can participate in designing its areas and learn how to cultivate plants. Together, they build and maintain the space for the benefit of the entire community.

Democracy works the same way. It flourishes when people can bring their energy, knowledge, and presence to the common ground. It works precisely because most of us want to nurture neighborhoods where every life can flourish — no matter where we live, the color of our skin, or the food we enjoy on our tables.

But today, reactionary political movements and governments worldwide are poisoning our gardens with the invasive weeds of their authoritarian policies and exclusionary legislation. According to the CIVICUS Monitor, 73 percent of the world’s population lives in countries where governments repress fundamental civil society freedoms.

By now, we know the playbook. Whenever authoritarians seize our common garden, they drive out those they deem dispensable first. Very often, LGBTI people, racialized persons, and migrants are at the forefront of weathering the storm. 

Only half a century ago, the wins that our movement has obtained seemed unthinkable. But those advances are always on the line, always one election away from the strongman of the hour deciding to unravel them.

On May 17, 1990, the World Health Organization removed homosexuality from the International Classification of Diseases (almost 30 years later, also in May, the removal of “gender identity disorder” followed.) The world celebrates this anniversary every year as the International Day against Homophobia, Transphobia, and Biphobia. This was a milestone in the global struggle for the rights of LGBTI people. Back then, 114 countries and territories worldwide still criminalized consensual same-sex sexual acts. Today, still 65 of them maintain those laws.

Progress has been steady. But in 2025, for the first time in years, that number started to grow again. Burkina Faso introduced a criminalizing law for the first time in its history. Trinidad and Tobago reversed recent gains. Senegal further tightened the threat after years of intensifying violence

The obsession of legislators and policymakers with people’s bodies has translated into paroxysmal attacks against trans and intersex folks — from the 771 bills currently under consideration in the United States, to the disgraceful and misguided policy of the International Olympic Committee reintroducing sex testing and banning trans and intersex women athletes from competing in the female category.

And isn’t it ironic, really, that legislators worldwide put so much effort into driving LGBTI people out of public spaces, when at least 61 UN member states still have legal barriers that prevent civil society organizations working on sexual, gender and bodily diversity issues from formally registering and operating?

Political scientists Phillip Ayoub and Kristina Stoeckl, writing in the “Journal of Democracy”, show that illiberal governments deliberately deploy state-sponsored LGBTI-phobia to mobilize constituencies and frame liberal democracy as a cultural threat. These governments weaponise democratic pluralism for endless culture wars. 

The playbook passes from one authoritarian to the next, activist Rémy Bonny showed. What started in Russia in 2013, with a law against the “promotion of non-traditional sexual relationships,” has grown into a pattern that illiberal leaders worldwide use to silence opposition and gain international influence amongst conservatives.

What makes this strategy particularly vicious is how it pits discriminated groups against one another. Time and again, reactionary people in power speak of “protecting women” just to attack trans and intersex people — manufacturing conflict among communities that, in fact, share a common struggle to protect the freedom to decide over their own bodies.

Whenever governments need to distract the public from their failures to create a better garden for everyone, they need a scapegoat. More often than not, it is LGBTI folks. Often, it is those fighting for safe abortions or against racism. Some other times, it is those advocating respectful relations with our land and natural resources. But the attacks never stop at a single movement. Case in point? Only 10 days ago, a government caved in to foreign influence and cancelled the largest global gathering on human rights in the digital age.

At ILGA World, we serve and work with LGBTI communities globally. We know that time and again, LGBTI people have resisted these pests, rolled up their sleeves alongside all the good people caring about their communities, and sown the seeds of change.  

This year, the world will join to celebrate May 17 under the theme “At the heart of democracy.” Because, as disillusioned with the concept as people may be, deep down most of us believe that we all deserve a space where we can feel safe and thrive. And together, we can contribute to the beautiful, shared community garden that we deserve.

Julia Ehrt (she/her) is the Executive Director at ILGA World and a widely respected LGBTI activist and community leader. 

Before joining ILGA World, she was the Executive Director of Transgender Europe, where she contributed significantly to how trans issues are perceived and debated today in Europe and beyond. She served as a founding Steering Committee member of the International Trans Fund (ITF) until 2019 and as a board member of the Association for Women’s Rights in Development (AWID) for six years. She is a member of the board of directors of the Astraea Lesbian Foundation for Justice, and a signatory to the Yogyakarta Principles plus 10

Julia holds a PhD in mathematics and lives with her partner and child in Berlin and Geneva.

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‘Live Your Pride’ is much more than a slogan

Waves Ahead forced to cancel May 17 event in Puerto Rico

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(Courtesy image)

On May 5, I spoke by phone with Wilfred Labiosa, executive director of Waves Ahead, a Puerto Rico-based LGBTQ community organization that for years has provided mental health services, support programs, and safe spaces for vulnerable communities across the island. During our conversation, Labiosa confirmed every concern described in the organization’s public statement announcing the cancellation of “Live Your Pride,” an event scheduled for Sunday in the northwestern municipality of Isabela. But beyond the financial struggles and organizational challenges, what stayed with me most was the emotional weight behind his words. There was pain in his voice while describing what it means to watch spaces like these slowly disappear.

This was not simply the cancellation of a community event.

“Live Your Pride” had been envisioned as a celebration and affirming gathering for LGBTQ older adults and their allies in Puerto Rico. In a society where many LGBTQ elders spent decades hiding parts of themselves in order to survive, spaces like this carry enormous emotional and social significance. They become places where people can finally exist openly, without fear, apology, or shame.

That is why this cancellation matters far beyond Isabela.

What is happening in Puerto Rico cannot be separated from the broader political climate unfolding across the U.S. and its territories, where programs connected to diversity, inclusion, education, mental health, and LGBTQ visibility increasingly find themselves under political attack. These changes do not always arrive through dramatic announcements. More often, they happen quietly. Funding disappears. Community organizations weaken. Safe spaces become harder to sustain. Eventually, the absence itself begins to feel normal.

That normalization is dangerous.

For years, organizations like Waves Ahead have stepped into gaps left behind by institutions and governments, particularly in communities where LGBTQ people continue facing discrimination, social isolation, economic instability, and mental health struggles. Their work has never been limited to organizing events. It has involved accompanying people through loneliness, trauma, rejection, depression, aging, and survival itself.

“Live Your Pride” represented much more than entertainment. It represented visibility for LGBTQ older adults, many of whom survived decades of family rejection, religious exclusion, workplace discrimination, violence, and silence. These are individuals who came of age during years when living openly could cost someone employment, housing, relationships, or personal safety. Many learned to survive by making themselves invisible.

When spaces like this disappear, something deeply human is lost.

A gathering is canceled, yes, but so is an opportunity for healing, connection, recognition, and dignity. For many LGBTQ older adults, especially in smaller municipalities across Puerto Rico, these events are not secondary luxuries. They are reminders that their lives still matter in a society that too often treats aging and queer existence as disposable.

There are still political and religious sectors that portray the rainbow as some kind of ideological threat. But the rainbow does not erase anyone. It illuminates people and stories that society has often tried to ignore. It reflects the lives of young people forced out of their homes, transgender individuals targeted by violence, older adults aging in silence, and families that spent years defending their right to exist openly.

Perhaps that is precisely why the rainbow unsettles some people so deeply.

Its colors expose abandonment, hypocrisy, inequality, and fear. They force societies to confront realities that are easier to ignore than to address honestly. They reveal how fragile human dignity becomes when political agendas decide that certain communities are no longer worthy of protection, funding, or visibility.

The greatest concern here is not solely the cancellation of one event in one Puerto Rican town. The deeper concern is the message quietly taking shape behind decisions like these — the idea that some communities can wait, that some lives deserve fewer resources, and that safe spaces for vulnerable people are expendable during moments of political tension.

History has shown repeatedly how social regression begins. Rarely with one dramatic act. More often through exhaustion, silence, budget cuts, and the slow dismantling of organizations doing essential community work.

Even so, Waves Ahead made one thing clear in its statement. Although “Live Your Pride” has been canceled, the organization will continue providing mental health and community support services through its centers across Puerto Rico. That commitment matters because people do not survive on slogans alone. They survive because somewhere there are still open doors, trained professionals, supportive communities, and people willing to remain present when the world becomes colder and more hostile.

Puerto Rico should pay close attention to what this moment represents. No healthy society is built by weakening the organizations that care for vulnerable people. No government should feel comfortable watching community groups struggle to survive while attempting to provide services and compassion that public institutions themselves often fail to offer.

The rainbow has never been the problem.

The real problem is the discomfort created when its colors force society to confront the wounds, inequalities, and human realities that too many people would rather keep hidden.

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He is 16 and sitting in a Cuban prison

Jonathan David Muir Burgos arrested after participating in anti-government protests

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Jonathan David Muir Burgos remains in a Cuban jail. (Graphic by Ignacio Estrada Cepero)

Jonathan David Muir Burgos is 16-years-old, and that fact alone should force the world to stop and pay attention. He is not an armed criminal, nor a violent extremist, nor someone accused of harming others. He is a Cuban teenager who ended up behind bars after joining recent protests in the city of Morón, in the province of Ciego de Ávila, demonstrations born out of exhaustion, desperation, and the growing collapse of daily life across the island.

Those protests did not emerge from privilege or political theater. They erupted after prolonged blackouts, food shortages, lack of drinking water, unbearable heat, and a level of public frustration that continues to deepen inside Cuba. People took to the streets because ordinary life itself has become increasingly unbearable. Families are surviving for hours and sometimes days without electricity. Parents struggle to find food. Entire communities live trapped between scarcity and silence.

Jonathan became part of that reality.

And today, he is sitting inside a Cuban prison.

The World Health Organization defines adolescence as the stage between approximately 10 and 19 years of age, a period marked by emotional, psychological, and physical development. That matters deeply here because Jonathan is not simply a “young protester.” He is a minor. A teenager still navigating the fragile years in which identity, emotional stability, and personal growth are being formed.

Yet the Cuban government chose to place him inside a high-security prison alongside adults.

There is something profoundly disturbing about a political system willing to expose a 16-year-old boy to the psychological brutality of prison life simply because he exercised the right to protest. A prison is never only walls and bars. It is fear, humiliation, emotional pressure, intimidation, and uncertainty. For a teenager surrounded by adult inmates, those dangers become even more alarming.

The situation becomes even more serious because Jonathan reportedly suffers from severe dyshidrosis and has previously experienced dangerous bacterial infections affecting his health. His condition requires proper medical care, hygiene, and adequate treatment, precisely the kind of stability that is difficult to guarantee inside the Cuban prison system.

Behind this story there is also a family living through a kind of pain impossible to fully describe.

Jonathan is the son of a Cuban evangelical pastor. Behind the headlines there is a mother wondering how her child is sleeping at night inside a prison cell. There is a father trying to hold onto faith while imagining the emotional and physical risks his teenage son may be facing behind bars. Faith does not erase fear. Faith does not prevent parents from trembling when their child is imprisoned.

And this is where another painful contradiction emerges.

While a Cuban pastor watches his son remain incarcerated, there are still political and religious voices outside Cuba romanticizing the Cuban regime from a safe distance. There are people who speak passionately about justice while remaining silent about political prisoners, repression, censorship, and now even the imprisonment of adolescents.

That silence matters.

Because silence protects systems that normalize abuse.

For too long, parts of the international community have spoken about Cuba through ideological nostalgia while refusing to confront the human cost paid by ordinary Cubans. The reality is not romantic. The reality is families surviving in darkness, young people fleeing the country in massive numbers, parents struggling to feed their children, and now a 16-year-old boy sitting inside a prison after joining a protest born from desperation.

No government has the moral right to destroy the emotional and psychological well-being of a teenager for exercising freedom of expression. No ideology should stand above human dignity. And no institution that claims to defend justice should remain indifferent while a child becomes a political prisoner.

Jonathan David Muir Burgos should not be in prison.

A 16-year-old boy should not have to pay for protest with his freedom. 

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