The Future of Our Mental Health System
BY VICTORIA SGARRO
About ten months ago, a 20-year-old man walked into a Connecticut elementary school and fatally shot twenty children and six adults. The shooting at Sandy Hook Elementary School sparked a renewal of the never-ending national debate over gun rights and violence. As a traumatized country searched for answers, the conversation turned toward a new, often stigmatized topic: mental health. Mental health awareness advocates faulted the American mental health system for the shooting in Connecticut and tragedies like it (the shooting in Aurora, Colorado occurred only six months earlier, and the one in Tucson, Arizona a year earlier). In response to the devastating events at Sandy Hook Elementary, President Obama has spoken of the need for a mental health care reform, reiterating this point at the National Conference on Mental Health in June. Now that the January 1st effective date of his Affordable Care Act (ACA), better known as “Obamacare,” is fast approaching, could a change actually be in sight?
The short answer is, maybe.
Currently the American mental health system is fragmented and non-comprehensive at best. About 20 percent of Americans with health insurance have no mental health coverage, and about a third have no coverage for substance abuse treatment. Without access to affordable treatment, many people with low-income levels and mental health problems end up in prison. The ACA strives to fill these gaps in coverage by expanding the mental health and substance use disorder benefits of approximately 62 million Americans. Of these 62 million, 32 million will receive coverage for the first time and 30 million others will experience improvements in their mental healthcare coverage.
So what will this expansion of coverage mean in terms of policy exactly? The answer requires backtracking a few years. Many Americans are unaware that a major mental health care bill, the Mental Health Parity and Addiction Equity Act (MHPAEA), passed in 2008. The law did not receive much attention at the time because it was attached to the $787 billion economic stimulus pack- age. However, its passage essentially redefined mental healthcare in the United States, putting mental health conditions on equal ground with physical health conditions. Under the MHPAEA, if an employer offers both physical and mental health care coverage in its insurance plan, then those coverages must be deemed equivalent. This means that out- of-pocket expenses, deductibles, and treatment restrictions of mental illnesses must be comparable to those of physical illnesses. Essentially, a person’s right to receive treatment for depression must be the same as his or her right to receive treatment for a broken leg. This idea in itself was a major victory for mental health advocates. However, this victory did not come without a few caveats. Firstly, the law only applies if an employer al- ready offers mental health care coverage under its insurance plan; it says nothing about requiring anyone to offer it. Additionally, small businesses are immune to this law. And needless to say, people without health insurance did not benefit at all.
This is where Obamacare comes in. The Department of Health and Human Services announced that adequate coverage for mental health care and substance abuse is one of the ten “Essential Health Benefits” that an insurer must offer under the ACA. This means that all of the people who do not have healthcare now will have both men- tal and physical coverage when the ACA takes effect. Thus, all of the newly insured will receive the benefits of the MHPAEA. This change is especially important be- cause among today’s 32 million uninsured Americans, there is a high prevalence of untreated mental health problems. More- over, because the ACA says that no one can be denied care based on a pre-existing condition (including a mental health condition), every American will have access to the mental health treatment that he or she needs.
Nevertheless, January 1st will not signal the end of all problems with our mental health system. Although coverage will greatly increase under the ACA, there is not an expected accompanying increase in the number of trained psychiatrists and addiction counselors. Therefore, coverage may not truly translate into access. Furthermore, Obamacare permits all states to adjust the definition of the “Essential Health Benefits” based on the needs of their citizens. Thus, actual implementation of the law might be different across the country, allowing one state to cover more expensive prescription antipsychotic drugs than another. The alcohol rehab near fort lauderdale can also help with de-addiction from other substance abuse.
Despite these concerns, the Affordable Care Act is a step in the right direction. It sets a higher standard for mental health coverage, ensuring that citizens’ mental health illnesses be taken as seriously as and be treated with as much respect as their physical illnesses, regardless of who they are. Living up to this standard will be difficult in practice, but the fact that we are asking more of our mental health system is the first step in reaching it.