The first step in addressing the issue of mental health parity is to create awareness about issues that actually do happen. So many times in our society, we like to pretend something didn't happen, we like to say it isn't real, we like to live in our glass houses and say there is something wrong with the person complaining rather than addressing the real issue. That is why it is so important to educate others. Educating others provides them with more knowledge and information and may help them to change their beliefs. Many may have misconceptions or may be unaware of issues that happen every day around them.
Why Should We Care About Mental Health Parity?
Mental illness not only affects the individual with mental illness; it affects family, friends, neighbors, schools, classmates, and the community at large. Not only is the indvidual affected by mental illness, but everyone around them is affected as well.
Issues arise when someone receives improper care for a mental health concern. Either the individual did not receive proper mental health treatment because it was not available or accessible to them, the mental health issue was stigmatized, the mental health issue was poorly treated or managed, or the mental health issue was treated as an acute rather than a chronic condition.
The Stigma of Mental Illness
Mental health parity issues have resulted because of misconceptions in care and the stigma of mental illness in our society. From 1752 to 1963, over two hundred years of American history, the mentally ill were separated from the rest of society in asylums, or psychiatric hospitals as they were later called. Of course, the early hospitals were considered more barbaric because patients were chained to walls. However, even as time went on, patients were still restrained for hours a day, had portions of their brains removed to "treat" the illness, and had high voltages of electricity sent through their bodies. Thus, the stigma that mental illness was an acute problem, but not a disease, began.
Since deinstitutionalization, the country has changed course and attempted to make care more humane and to educate others to reduce the stigma of mental illness. In 1979, the National Alliance for the Mentally Ill was founded. Its purpose was to offer "support, education, and advocacy...for the mentally ill." Pharmaceuticals were used to treat severe mental illness to mild depression and anxiousness. The use of drug therapy became so commonplace in society, that the Rolling Stones even wrote a song entitled, "Mother's Little Helper." The song was about the commonplace usage of a psychotropic medication.
The Inequality of Mental Health Care
Because of the history of stigmatization of mental illness in the first half of America's history, which was then followed with the almost flippant use of mental health terms, mental illness has carried with it a great deal of stigma. There are those who believe if you comment about their family member's mental health issue that you are picking on him/her. However, stating to someone they need to be aware a family member's clinical depression is not "being mean" any more than saying they need to be aware of a family member who has diabetes. In reality, the family has a stigmatized perception of its relative's mental illness. This may be attributed to the lack of knowledge and understanding about mental health issues. Thus, rather than encouraging treatment for the family member, the family villainizes the so-called persecutor, or the person who suggested treatment may be an option. Further, because mental health is so greatly stigmatized, others view it as an insult rather than an illness. This stigmatization has created a gap in care for those who suffer with mental illness in the form of available and accessible care.
Moreover, because of the stigmatization surrounding mental health care, it has not been viewed as a priority to our society. Rather, it has been treated as a family secret, something to be hidden under the rug, something for hospitals to deal with, or to keep quiet and ignore. As a result, treatment options for the mentally ill were limited for years. Outpatient assessments were limited to five visits or less, as if mental health problems could be resolved in that short time period. Reimbursements were lower from insurance and copays were higher. Today, the Affordable Care Act states that individuals must receive the same health benefits as available for physical health problems. Even with the Affordable Care Act, coverage for mental health treatment falls short.
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Furthermore, because of poor reimbursements, inpatient and outpatient mental health treatment programs were, and still are, a considerable drain on hospital finances. Medicaid currently provides 26%, $9.86 billion, of mental health payments to providers. However, the reimbursement rate is still lower than for other insurers. With close to 26% of Medicare recipients needing mental health services, Medicare is also a large payer for mental health care. Unfortunately, Medicare reimbursements are also low. Medicare Part A covers up to 190 days of inpatient care during the lifetime. That is only a little over 6 months of covered inpatient care for those receiving Medicare. Reimbursement rates may be as much as 80% after deductibles are met. In comparison, an inpatient hospitalization for cancer treatment is 100% covered for the first 60 days and may decline after the first 60 days. Because of the Affordable Care Act, lifetime limits on coverage for chronic illnesses, such as cancer, are no longer permissible. Therefore, parity does not exist for chronic physical illness and chronic mental illness. That is lifetime limits do not exist for chronic physical illness but lifetime limits do exist for chronic mental illness. As a result, mental health treatment, both inpatient and outpatient, become a loss leader for hospitals, health systems, health departments, and outpatient clinics. The programs become a drain on the facilities' finances and must be offset by other areas. Some healthcare organizations may choose to drop mental health services all together. Practitioners are difficult to recruit and retain when reimbursements and available resources are low. As a result, fewer programs are available to treat patients. This then affects patients, their families, hospitals, and communities at large because there is a lack of accessible and available mental health care treatment options.
Advocating for Change for Mental Health Parity
In order to create change for mental health parity, communities must begin by creating awareness for mental illness. Screening programs should exist, as they do for physical ailments. Through the creation of screening programs, an opportunity exists to educate others - practitioners and the community at large - about what truly constitutes mental illness and what treatments options are available. Communities, health systems, and citizens, need to advocate for change in reimbursement levels for mental health care. Low reimbursements suggest that mental health treatment is a low priority.
In the past, the World Health Organization has reported that the Americas have been eradicated of measles. Although the Americas may never be eradicated of mental illness, there are other issues that can be. Eradication of mental health stigmatization may be developed through education, appropriate and accessible mental health treatments options may be made more available through early and available screening, and low reimbursement rates may be eradicated through fair and equitable payment systems.
Sources
Mental Health and Substance Abuse Disorder Parity. Department of Labor, found online at
CMS finalizes mental health and substance abuse disorder parity rule for Medicaid and CHIP, Centers for Medicaid and Medicare Services, found online at
Diseases of the Mind: Highlights of American Psychiatry through 1900, NIH, National Library of Medicine, found online at
Module 2 A Brief History of Mental Illness and the U.S. Mental Health Care System, Unite for Sight, found online at
Prozac. Chemical and Engineering News, found online at
Billing Health Billing. CMS.gov, found online at
Medicaid plans struggle to provide mental health services. Modern Healthcare, found online at
Medicare and Mental Health. Center for Medicare Advocacy, found online at
Medicare and Your Mental Health Benefits. Centers for Medicare and Medicaid Services, found online at
Lifetime and Annual Limits. HHS.gov, found online at
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