Mental Health Parity

Abstract

            Most employers have mental health care benefits included in their health plans but it is very limited compared to other benefits like surgical or medical.  The Mental Health Parity Act aims to bridge the gap between physical and mental health care benefits.  There is the ongoing debate as to the covered benefits by the legislation.  The public is in favor for mental health parity but it does not extend to the inclusion of substance abuse.  The Democrats vying for the presidency include mental health care in their campaign.  Nurses are involved in the treatment of patients and held to a degree of standard care.   Their patients who need mental health services will benefit from their knowledge of mental health parity.

Introduction

            The Mental Health Parity Act was first introduced in September 26, 1996 and signed by President Bill Clinton.  It is a federal law that prohibits restricting the mental health care benefits provided by employers in the coverage of their health plan.  It has been extended six times and ran through December, 2007 (Employee Benefits Security Administration, 2007).

After years of lobbying, it is now known as S558 or the Mental Health Parity Act of 2007.  It ensures the mental health care benefits for group health plans that include medical, surgical and mental health benefits will not be more restricted than the medical or surgical benefits in the health plan in terms of financial requirements including deductibles, copayments, coinsurance, out-of-pocket expenses and annual and lifetime dollar limits.  It also applies to treatment limitations like frequency of treatment, number of outpatient visits, number of covered inpatient days or other similar limits or the duration of treatment (Library of Congress, 2007).  However it does not force health insurance providers to offer mental health care benefits in their group health plans or the standard level of care.  It also does not prohibit negotiation of separate reimbursement, higher copayments and higher premiums.  It exempts employers with 50 or less employees within the preceding year or the current year for employers who have started in the current year and employs 50 persons or less.  This bill is sponsored by Sen. Pete V. Domenici (NM) and was introduced in Senate on February 2007.  It was referred to House Subcommittee on Health, Employment, Labor and Pensions on October 2007.

            Similar bills have also been introduced.  The S486 or the Sen. Paul Wellstone Mental Health Equitable Treatment Act of 2003 provides equal coverage of mental health benefits with respect to health insurance coverage unless comparable limitations are imposed on medical and surgical benefits which was sponsored as well by Sen. Pete V. Domenici (NM).

There is also the S646 or the Medicare Mental Health Modernization Act of 2003 that amends title XVIII of the Social Security Act to expand and improve coverage of mental health services under the Medicare program.  It repeals the 50% copayment for the outpatient mental health services with the standard 20% copayment for which all other outpatient services are assessed.  However this bill was not highlighted by President Bush (Ron Sterling, 2006).

Public Opinion

            The stigmatization of people with mental disabilities or disorders prompts several grass roots activists to champion the cause and to lobby for mental health parity.  Several surveys have been conducted by numerous organizations to determine the general position on mental health parity.  Survey shows that the people are generally sympathetic to the cause and are in agreement for mental health parity with medical and surgical benefits in group health plans however the support does not extend to substance abuse coverage in the expansion (Kristina W. Hanson, 1998).  Their support however wanes due to fear of tax increase and premiums.  This may also be due to lack of comprehensive knowledge about mental health disorders about what are the causes and the effect it has on the person and to those around them.  Better information dissemination about it and the awareness of their benefits from the mental health parity act may increase the willingness of the public to support mental health parity.

            According to the National Advisory Mental Health Council (NAMHC) the benefits of mental health parity are: 1) overcoming discrimination against the mentally disabled; 2) prevention of health plans from being financially disadvantaged as parity in all plans levels the playing field; 3) reduces out-of-pocket expenses of the mentally disabled and their families; 4) facilitates access to appropriate treatment; and 5) the persons affected by mental illnesses are more productive and contributes more to the community.  With the expansion there are also costs but the most is estimated to be a 3.4 percent increase of premiums for family coverage (Bee & Gibson, 1998).

            Some are wary of parity due to the vagueness of the diagnoses of mental health and substance abuse that result in stricter limits on coverage in health plans.  Some favor reducing the basic general services included in the plan to accommodate mental health care benefits.  Private and public sectors alike impose stricter measures for mental health care benefits and substance abuse treatments by limiting number of days covered, outpatient visits and financial coverage.

            The economists are also of two minds.  Some argue that because of imposed stricter measures to mental health care benefits those who need it the most are deprived of it especially since they have the more expensive needs.  However others argue the possible abuse of the generous mental health and substance abuse treatments.

            Employers also argue that it would raise the cost of health insurance because it would require equal treatment for trivial issues such as jet lag, academic problems and spiritual crises.  However, a study in California regarding their mental health parity bill which covers only selected mental health conditions show that there were no significant increase in health insurance premiums in its first year of implementation (Hoover, 2002).

            The public supports mental health parity but hesitant of including substance abuse in the expansion probably because they think that it is because of that person’s own decision and action that he/she suffers from it.  However public awareness about mental health disabilities as well as current policies will make for a better understanding and legislation of mental health parity as it will also put the pressure on state and federal politicians to act.  It will depend on the exact wording and the packaging of the health plan for the public to determine its support for the bill per se.

            With the approval of this legislation, more Americans will be able to avail of the mental health care that they need.  Studies show that older people are in more need of mental health care services (Ron Sterling, 2006).  Since most seniors live on a fixed income, they do not get the mental health care services that they need thus compounding their afflictions.  They have to get more medications and treatments thus incurring higher expenses.

Presidential Candidates on Mental Health Parity

            Among those vying for the presidency only the Democrats, namely Hillary Clinton and Barrack Obama, mention mental health parity or mental health care in their campaigns.  Obama champions the cause of mental health parity and believes that serious mental disabilities should be covered equally with medical and surgical benefits in group health plans.  He believes that there should not be any discrimination towards the mentally disabled especially by health plan providers.  However, he does not include specifics about premium raises.

An Outlook on Mental Health Parity

            Mental health parity will greatly benefit those who are mentally disabled as it would allow them access to needed mental health care.  It is not right for those who have disabilities to be discriminated against.  Everybody deserves to be functional and be productive individuals to the community.

            Forty to 60 percent of people affected by mental illness do not get medical treatment.  In a NBC News special, “Back to Bedlam” by Geraldo Rivera, there were persons suffering from medical illness who could not get any treatment were imprisoned instead (Bee & Gibson, 1998).

            Those who do not have insurance or health policies have little chances of getting the level of care that they need in order to function normally day to day.  Even with health insurance plans, because of the stringent measures imposed on mental health care services, persons with a tight budget often forego the treatment.

            What we need is to commit ourselves to help and support mental health parity.  Even if we are not affected by mental illnesses, which we should be thankful for, it is only prudent to consider the long term benefits that we may get.  We can not be assured that we will not need it in the future, so we should not oppose it on the basis that we think we need it less likely.

            Mental illness is as serious as cancer in that it affects the community as much as any other serious illness.

Registered Nurses on Mental Health Parity

            Registered nurses are involved in the treatment of the patient, they educate the patient and the public about medical conditions while giving advice and emotional support to the patient and their families (Bureau of Labor Statistics, 2007).  It is important for nurses to be involved and knowledgeable about mental health parity and the current policies because in doing so they can provide the patient needed support.  They can educate the patient and their families what treatments they can avail thereby promoting better health.

            Nurses may specialize in geriatrics or the care of the elderly and since this is where mental health care is most needed their knowledge of mental health parity would be very useful.  There are also psychiatric nurses, intellectual and developmental disabilities nurses, and pediatrics.  Nurses may also be employed in health planning and development, or by health policy providers in marketing, consulting, policy development and quality assurance.  The support that nurses can give to mental health parity will advance the development of the bill.  By their participation in the dissemination of information to the public, it strengthens the awareness of the public to the issue and their reception to the proposed legislation will prompt state and federal politicians to improve the health care services in general.

References

Bee, S., & Gibson, M. J. (1998, September). AARP Public Policy Institute. NW, Washington, DC.

Bureau of Labor Statistics, U. D. (2007, December 31). Occupational Outlook Handbook, 2008-09 Edition. Retrieved February 3, 2008, from Registered Nurses: http://www.bls.gov/oco.ocos083.htm

Employee Benefits Security Administration. (2007). US Department of Labor.

Hoover, K. (2002, May 3). Employers oppose new mental health mandates. Puget Sound Business Journal (Seattle) .

Kristina W. Hanson, B. (1998). Public Opinion and the Mental Health Parity Debate: Lessons From the Survey Literature. Psychiatric Services , 49: 1059-1066.

Library of Congress. (2007). Retrieved February 2008, from Thomas.

Read, K., & Purse, M. (2008, January 31). About.com. Retrieved February 2008, from Mental Health Care – Campaign 2008: http://www.about.com

Ron Sterling, M. (2006, May 11). Mental Health Activist. Retrieved February 2008, from MentalHealthActivist.org: mentalhealthparity.com