Flickr: Elja Vellekoop

By  Eric Bitet, LMHC, MA, MPH

Did you ever stop and consider the cost of talking to a professional about your problems?  Have you been feeling increasingly depressed or anxious recently, overly stressed or worried about your job, finances, or your shrinking property value?  Have you been overcome by malaise or sadness as you remember a lost loved one during this holiday season and wanted to speak to a therapist but were scared of what your out-of-pocket expense would be?  If your answer is “Yes,” you are not alone and many people struggle with problems like these.  These are a few examples of stressors that affect millions of people in the United States and around the globe every year.  The American Psychology Association (APA) reports that in any given year, 1 in 10 Americans overall suffer some disability from mental illness.  Of these millions of American, many have insurance that offers limited benefits for mental health while others are uninsured and must qualify for their state Medicaid programs to have access to treatment.

When these kinds of mental health related problems arise, where do these people go for help?  Well, the first step can be to contact your primary care physician and request a referral to talk to a mental health professional whether it be a psychiatrist, psychologist, or a psychotherapist.  But how will it be paid for?  Do health insurance plans cover mental health care?  Most insurance companies do provide some level of coverage but the pressing issue here is how much?  The answer in most cases is not enough!  The readers will be the judge on whether mental health treatment coverage should be equivalent to coverage provided by insurance companies for physical illnesses but how many of us have thought critically about this issue?  Do you believe that schizophrenia and bipolar (manic-depressive) disorder should be treated the same as physical illnesses in health insurance plans by providing the same amount of cost coverage and inpatient and outpatient treatment visits?

While you ponder this question lets briefly explore the facts.  History shows that physical and mental health has long been treated with great inequality and has only begun to make strides towards parity within the last decade. The struggle of mental health advocates against cost-containment policies that restrict mental health benefits has raged on since the 1980s.  The Mental Health Parity Act of 1996 was a significant first step towards parity as it addressed “catastrophic” benefits and put the issue on the map for policymakers.  The new act prohibited lifetime and annual limits on coverage that were different for mental and physical illnesses.  This was a positive first step for mental health advocacy but barely scratched the surface of the issue as many areas were not addressed.  A report by the Surgeon General indicates that the Mental Health Parity Act did not address other forms of benefit limits such as per episode limits, visit limits, co-payments or deductibles, and substance abuse treatment.

A decade after the Mental Health Parity Act was implemented, mental health advocacy groups have continued their mission to bring parity to mental health insurance coverage and the arguments have been heard by policy and law makers in state governments and on Capitol Hill.  There are 42 states that have followed suit and since enacted their own parity laws requiring mental health coverage to be par with physical health coverage.  In 2008, after a long 10 year battle for equality, President George W. Bush passed a “Mental Health Parity” law that will mandate the equal coverage for depression, bipolar disorder and all other diagnosable mental illnesses with physical illnesses like heart disease and cancer.  As of January 2010, health insurance companies and group health plans will no longer be allowed to impose different limitations on mental health and substance abuse treatment coverage than they do for medical treatment.  At this time, the new law will only exclude those people who are employees of companies with 50 or fewer workers and those who purchase their own insurance.  So there are still some loopholes and speed bumps along the road for mental health parity, but this new law is a monumental victory for mental health advocates who have fought hard to bring mental illness to the mainstream of our society as something that is very important and to be treated seriously!

Up to this point, research indicates that cost is one of the biggest deterrents that prevent people from seeking treatment for mental health related issues.  Well now help is on the way and mental health care should come cheaper and easier for most Americans.  So where do you begin on your journey to access treatment if your experiencing some type of mental health related problem?

Here are some tips that might be helpful:

• Contact your Primary Care Physician (PCP) and make an appointment to discuss issue and request a referral to speak to a mental health specialist.
• Contact your insurance companies who have clinically trained case managers ready to take your call and refer you to the proper level of treatment.
• Many employers have Employee Assistance Programs (EAP) that are staffed with counselors that are prepared to help employees manage and cope with any type of stressful situations whether it is personally or professionally related.
• In the most severe situations, if you are having any thoughts of harming yourself or anyone else, you must call 911 or visit your nearest emergency room right away!

So as we conclude this article, I challenge you to think about what mental illness means to you and think about all the stigma associated with having a mental illness.  Have these stereotypes had an effect on how the American health care system and more importantly insurance companies viewed mental illness and why they didn’t cover its care to the same extent as medical?  Is it possible that something so serious can be taken this lightly and left in the dark for this long?  Whether the answer be yes or no will be left for you to decide!  I will leave you with one reality though; the dark ages of ignorance and prejudices against mental illness are behind us and a new age of public awareness is now here. This is depicted by these mental health parity laws and the conformity of insurance companies!  So where do you stand on this issue and so you think we are there yet?