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Mental Health Parity: A Place for Health Communicators

By: Kelley Talbot

Mental health care in America is evolving. Treatment options have multiplied, access to care has increased, and attitudes towards mental health are shifting. Yet the pace of change seems maddeningly, needlessly slow to some: Only half of Americans with mental health conditions get the care they need, according to the National Alliance on Mental Illness.

The good news: Health communication professionals can play a meaningful role in improving access to mental health care and reducing stigma related to mental illness.

Lifting the Barriers

Segregating mental health from physical health has been a barrier to treatment. Patients, doctors, insurers and broader cultural attitudes have all played a role. But the pendulum is shifting. As the biological underpinnings of many mental illnesses are better understood, some patients and families are less likely to see mental illness as a character flaw that can be overcome if the patient “just tries hard enough.” Patients are less likely to be blamed.

When that happens, people who might once have suffered in silence are more likely to ask for help. And today’s choices look different than earlier generations’. There’s more treatment rooted in research, more personalized care, and advocates fighting for more integrated systems of community care.

Changes to Insurance

There’s another hurdle to getting help being knocked down: Insurance companies’ history of offering extremely limited mental health coverage. Traditionally, many insurers forced people to pay larger out-of-pocket costs for mental health care than for “physical” care, limited the amount of care (or number of visits) covered, or had very small groups of in-network providers. This made treatment expensive, could keep people from getting enough care at the right time, and made it very hard to find a doctor.

Enter the federal Mental Health Parity and Addictions Equity Act. Passed in 2008, the act prevents covered plans from imposing more restrictive treatment limits or higher out-of-pocket costs for mental health services than for “physical” services. The goal is to make mental health care more affordable and accessible. NAMI offers this example: “When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes then they must offer unlimited visits for a mental health condition such as depression or schizophrenia.” Today, most insurance plans don’t charge higher co-pays or separate deductibles for mental health services.

But there are shortcomings. The law does not impact all insurance plans – even though the Affordable Care Act expanded the number of plans subject to parity. And, NAMI explains: “Parity doesn’t mean that you will get good mental health coverage. Comprehensive parity requires equal coverage, not necessarily ‘good’ coverage. If the health insurance plan is very limited, then mental health coverage will be similarly limited.” Finally, there have been real gaps in on-the-ground implementation and enforcement. Former insurance company executives turned consultants label enforcement “a joke,” and advocates felt compelled to create the Parity Implementation Coalition.

Need for Health Communicators

A recent Kaiser Health News/NPR story by Jenny Gold reported on new recommendations from a presidential task force to reduce mental health care discrimination; supporters were pleased that more attention was being paid to the issue but felt that the recommendations didn’t go far enough.

Gold reports that former congressman Patrick Kennedy, one of the authors of the parity law, said “Much of what was released today still places the burden of real action squarely on the shoulders of the patients living with these conditions. [We] are asking these individuals to take up their own cases when they experience a parity violation, which usually occurs at the height of their crisis.” And Benjamin Miller, director of the Health Policy Center at the University of Colorado School of Medicine, said true parity will only come from erasing the lines between mental and physical health care. 

This area is ripe for change with the help of health communication professionals. The intent of the law is not enough to make it reality. Too many people still don’t understand their right to affordable treatment and either don’t seek care or give up when coverage is denied. Patients and doctors need easy-to-use information about what the policy means in terms of getting and paying for treatment. Patients and doctors need to know their options when coverage is denied illegally. And policymakers need to hear meaningful stories illustrating how lax enforcement has hurt patients when they were in crisis or suicidal. 

This translation of complex information into a set of clear action steps for patients or family members is a natural place for health communications to improve the patient experience. Insurance companies also continue to update their materials to comply with shifting state and federal regulations, and could benefit from communications experts. Parity laws have tremendous potential to help people live better. Clear communication will be essential to fulfilling it.