The National Alliance on Mental Illness (NAMI) released a report on the difficulties of finding appropriate, affordable mental health care. Even individuals with insurance have trouble finding in-network providers. Mental health care services are often more expensive than physical care. These services may not be available at all. The gaps between mental and physical health care coverage should not exist as they do. Parity laws and the Affordable Care Act have tried to remedy differences between mental and physical health care and treatment. NAMI discusses reasons for inequality and options for changing the addiction and mental health care landscape.
Why Is Mental Health Parity Important?
Mental health issues can be managed. Individuals can live with minimal, manageable symptoms or no symptoms at all. For example addiction is a treatable disease, but it requires just that: Treatment. The U.S. Surgeon General[1] shares, “Treatment is effective. As with other chronic, relapsing medical conditions, treatment can manage the symptoms of substance use disorders and prevent relapse. Rates of relapse following treatment for substance use disorders are comparable to those of other chronic illnesses such as diabetes, asthma, and hypertension. More than 25 million individuals with a previous substance use disorder are in remission and living healthy, productive lives.” A life without active addiction is within reach. Adequate insurance coverage brings this life even closer. When individuals can find the specific, appropriate care they need and they can afford this care, there is real hope for a healthy and happy future.
“More than 25 million individuals with a previous substance use disorder are in remission and living healthy, productive lives.” The U.S. Surgeon General
Differences in Mental and Physical Health Care Coverage
While parity laws promise easier access to mental health care, this has not equaled easy access to care. Individuals still have trouble finding mental health care resources. NAMI[2] found, “Only 87% of people needing psychiatric hospitalization (inpatient care) received treatment in an in-network psychiatric hospital, while 92% of people needing hospitalization for other medical conditions were able to receive services in an in-network hospital. In addition, people were more than twice as likely to have trouble finding a psychiatric hospital that would accept their insurance (19%) compared to other types of hospital care (8%).” Not all mental health patients require hospitalization.
Those stepping down from inpatient care or beginning their recovery journeys at a different point in health and life may choose outpatient services. Any addiction treatment should include therapy. However, NAMI found, “One in four people did not have a mental health therapist in their insurance network.” This statistic is true at the same time the U.S. Surgeon General announces, “Treatment for all substance use disorders—including alcohol, marijuana, cocaine, heroin or other opioid use disorders, among others—should include one or more types of behavioral interventions delivered in individual, group, and sometimes family settings.” Behavioral therapies like Cognitive Behavioral Therapy, Motivational Interviewing and Dialectical Behavior Therapy help individuals reestablish healthy thought and behavior patterns. They create the basis for managing mental health and addiction symptoms. Accessing the appropriate level of mental health and substance abuse treatment is a national concern. The government recognizes the importance of therapy, treatment and intervention. Insurance needs to make these tools readily available.
Why Is Mental Health Care Hard to Find?
Parity laws require most insurance providers to offer equal coverage for mental health care as physical health care. The Affordable Care Act considers mental health and substance abuse services one of ten essential health care benefits. Despite these efforts, finding mental health care is not as easy as finding physical health care. There are several reasons for this. NAMI explains there is a, “Critical nationwide shortage of mental health professionals, including psychiatrists and licensed therapists.” In-network providers may not be able to take new patients. There may be no available in-network providers in a given area. Many individuals must choose between traveling for treatment, paying out-of-pocket prices or foregoing care. Another reason for gaps in mental health care coverage is that providers may not accept insurance. NAMI found, “Only 55% of the nation’s psychiatrists accepted insurance compared with 88% of physicians in other medical specialties.” Accepting insurance takes time out of already over-booked schedules. Psychiatrists also report low reimbursement rates. Mental health care providers may not have the interest or incentive to deal with insurance companies. A final reason for gaps between mental and physical health care coverage also involves difficulties finding accurate directories of providers who do accept insurance and are taking new patients.
How Can Gaps in Care Be Fixed?
NAMI suggests several options for fixing treatment inequality. Accurate directories can help patients find professionals. New regulations could require that insurance companies cover out-of-network care as in-network care when the former isn’t available. Working with insurance companies could be made simpler and more rewarding for mental health care professionals. Integrating mental and physical health care can help dissolve the lines between the two. There is hope for affordable, accessible mental health care for everyone.
Sources
[1]https://addiction.surgeongeneral.gov/executive-summary/report/early-intervention-treatment-and-management-substance-use-disorders. Surgeon General’s Report on Alcohol, Drugs, and Health. Surgeongeneral.gov. 18 Nov 2016. Web. 25 Nov 2016.
[2]http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/Mental-Health-Parity-Network-Adequacy-Findings-/Mental_Health_Parity2016.pdf. “Out–of–Network, Out–of–Pocket, Out–of–Options: The Unfulfilled Promise of Parity.” National Alliance on Mental Illness. 15 Nov 2016. Web. 25 Nov 2016.
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