News-Letter

This is the final article in a three-part feature on mental illness. The series is being presented by Active Minds @ JHU, a group that aims to raise awareness and provide information on campus about mental health issues, encourage people to seek assistance as soon as it is needed and help reduce the stigma associated with mental illness.

Today, a broad range of mental illnesses are understood as legitimate medical problems, just like diabetes and AIDS. Effective treatments ranging from medications to therapy are available around the country. The stigmas against mental illness are slowly but surely eroding.

So why is it still so difficult to gain access to mental health treatment, even once a patient is diagnosed? The key to the problem is the way insurance companies offer and pay for treatment.

Access to care can be limited at many junctures. For instance, not all locations offer the same range of treatment services or quality of care. Mental health treatment is much more personalized than other forms of medical treatment, making it much more difficult to find a suitable source of treatment for each patient.

Availability can severely limit treatment options. Not all cities and towns offer a full range of psychiatrists, psychologists and counselors from which to choose. Even when suitable treatment options exist, options are limited to those the company decides to cover.

Unfortunately, the reality is that many mental health patients have a hard time finding insurance coverage for their problems; seen as "high-cost" patients, those with mental illness are not easily able to obtain health insurance.

"Parity" refers to the standard of treating mental health care the same way as general health services. There have been widespread efforts to expand mental health coverage under health care plans using the idea of parity.

There is an increasing gap in coverage between mental health and general health services. One study found that the number of employees with coverage for care has actually increased, but the benefits are fewer.

Existing coverage plans are often very limited, and do not provide enough care for the average mental health patient. According to reports from the surgeon general, patients are often limited to only $25,000 over their entire lifetime, or a maximum of $5,000 in a single year for inpatient care and another $2,000 for outpatient care. This will only cover a few weeks of care at many facilities, but most mental illnesses require expensive, life-long treatment.

There have been some efforts by Congress to address the problem. The Mental Health Parity Act, implemented in 1998, focuses on "catastrophic" benefits and prohibits use of lifetime and annual limits on coverage. But the coverage is different for mental and somatic illnesses, and the legislation applies only to some of the largest self-insured corporations.

Though a great first step, the federal law is limited in many ways. Companies with fewer than 50 employees or those that offer no mental health benefits are exempt from its stipulations. In addition, the legislation does not fix other limits on benefits including length of stay, number of visits, co-payments and deductibles. It also does not include anything on substance abuse treatment.

On the state level, much has been done to try to increase parity. Some states, such as Texas, have pushed for parity laws that include fewer people (those with severe mental illnesses) while other states, including Maryland, have used a broader definition for parity coverage. Some states have also included substance abuse treatment in their plans.

Coverage under these laws is not uniform within or between states. According to the National Alliance for the Mentally Ill, certain states, like Maryland, focus on a broad range of insured groups, while others target a single population. In Texas, the law only includes state employees.

In the long run, these state-wide efforts save on costs associated with mental health care. The surgeon general's report indicates that laws in Texas, Maryland, and North Carolina have led to declining costs after the introduction of parity legislation which affected managed care practices. While the number of users increased, average expenditures per user declined.

The only way to effectively give treatment to everyone who needs it is to treat mental illnesses and somatic illnesses with total parity. Public support for such parity laws is desperately needed across the country.

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