by Tyler Norris, Chief Executive, Well Being Trust
The country’s health care system is fragmented, with mental health often seen as separate from physical health. In practice, at the patient level, mental health services can be elusive for many — even those experiencing a crisis related to alcohol or drug misuse disorders, depression or suicide.
Sadly, our reality is that few individuals who have a mental health need obtain care.
The country is also 10 years into the implementation of the landmark federal law for mental health and substance misuse parity — a law that holds the promise of levelling the playing field and ensuring people in need obtain the care they deserve.
Unfortunately, since passage, state mental health parity laws — those which require insurers to cover mental health issues, such as depression or substance use disorders, at the same level as illnesses of the body, such as chronic or infectious diseases — were never enforced as strongly as they could be.
In a recent analysis of state statutes focused on enforcing parity, 32 states received a failing grade with only one state scoring above 79 (out of 100 possible points). There is much work to be done to address one of the biggest public health issues of our time: breaking down the silos and ensuring people who need treatment can access and afford mental health services.
To that end, Well Being Trust, in partnership with many others, intends to help lead a national policy approach focused on achieving mental health and substance misuse parity. Our goal: to change the structure, clinical design and financing of care, thereby allowing for mental health and substance misuse to be seamlessly integrated into traditional health care settings.
With such an encompassing issue as mental health, everyone involved in the public’s health has a role. According to the American Public Health Association, when it comes to mental health parity, public health agencies can create and support policies and programs that increase education about mental health parity laws, insurance plans and mental health services.
Additionally, as people on the frontlines helping mitigate a myriad of health issues facing communities and often incredibly vulnerable populations, public health advocates can galvanize and advocate for five major improvements to mental health parity statutes within their states:
- Mental health conditions must be recognized as broadly as physical health conditions and covered as comprehensively as physical diagnoses.
- Co-pays and out-of-pocket costs must be the same for mental health services as they are for physical health services. States should require benefit management processes and treatment limitations that are no more restrictive than those for similar physical health benefits. Mental health services must also have the same coverage limits.
- Policymakers should strengthen enforcement and compliance activities by empowering regulatory agencies to enforce parity laws. To ensure laws are being followed, states should require reporting on compliance and for health benefit plans to submit regular analyses demonstrating compliance.
- Policymakers should increase parity enforcement efforts and update oversight mechanisms through intensive compliance verifications and reviews of consumer complaints and by requiring health plans to submit detailed compliance analyses.
- States should designate a lead for parity with the resources necessary for regulating and enforcing parity and hire and fund consumer advocate offices to help patients understand, file and process claims and appeals.
True mental health care remains elusive for far too many. To improve the health of our communities, public health must help position mental health as an essential and core component to overall health and well-being.
Our nation’s most vulnerable cannot wait another decade — people need comprehensive mental health coverage and care now.
Tyler Norris, MDiv, is chief executive, Well Being Trust, an Oakland-based impact philanthropy with a mission to advance the mental, social and spiritual health of the nation. Over the past three decades, Norris has shaped health and development initiatives in hundreds of communities in the U.S. and around the world. He has an extensive background as a social entrepreneur, animateur, and trusted advisor to philanthropies, health systems, government agencies, and collaborative partnerships working to improve the health of people and places. Follow Tyler on Twitter: @TylerNorrisMDiv.
This was first published on the APHA Annual Meeting blog as part of the de Beaumont Foundation’s “Fresh Perspectives” series.