End this discrimination against people with mental illness and provide them with care

End this discrimination against people with mental illness and provide them with care
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Ten years have come and gone since the federal Mental Health Parity and Addictions Equity Act was passed. National Alliance on Mental Illness (NAMI) fought long and hard for the rights outlined in this landmark legislation — covering mental health and addiction care at the same level as other health care.

And yet, all these years later, equal coverage continues to remain elusive and people with mental health conditions still face discrimination by their health insurance providers.

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NAMI’s new survey report, The Doctor is Out: Continuing Disparities in Access to Mental and Physical Health Care, shows that very little has changed since the parity law was enacted. The survey assessed and analyzed the experiences of more than 3,000 private- and publicly-insured individuals in seeking mental health and primary and specialty medical care.

 

Sadly, the survey’s findings confirm that the issues of inequality which led to the original crafting of the federal parity law are still very much in existence. In contrast to people seeking health care for conditions like heart disease or diabetes, people living with mental illness simply don’t have the same access to specialists and facilities within their networks.

Nearly half of the tens of millions of adults and children living with mental health conditions in the United States continue to go without any treatment, and those who do seek treatment must navigate a difficult, fragmented and costly system full of obstacles.

Tragically, nearly 35 percent of respondents with private insurance say that they can’t find any mental health therapist who would accept their insurance. In contrast, only 13 percent reported difficulty finding a medical specialist. And these findings are consistent across rural, suburban, and even urban populations, where there is a greater supply of psychiatrists and other mental health professionals.

With a lack of in-network mental health professionals, more than 1 in 4 survey respondents (28 percent) who receive psychotherapy were forced to use an out-of-network provider (if they could afford it) for treatment. Not surprisingly, out-of-pocket costs for mental health care were also significantly higher than those for physical care. Co-pays and other costs exceeding $200 were more than one and a half times greater for use of mental health therapists and psychiatric prescribers than when using medical specialty care.

NAMI’s report was published simultaneously with the publication of a report from Milliman, funded by the Bowman Family Trust, that analyzed insurance data of 42 million people, over the course of three years, in all 50 states and the District of Columbia. The results confirmed the stark discrepancies that NAMI’s survey portrayed.

The Milliman report showed that nationally, in 2015, people went out-of-network for mental health and addictions care at 3.6 to 5.8 times the rate that they went out-of-network for primary or specialty medical care.

The researchers also discovered that primary and medical specialty care providers are paid, on average, 20 percent more than psychiatrists for office visits billed under the same or similar codes. At a time when suicide rates constitute a public health crisis, disparities of this magnitude are disturbing and unacceptable.

What needs to happen to end our country’s long-held discrimination against those with mental health conditions? What will it take to finally level the playing field?

NAMI is fighting for equity in mental health care, with policy recommendations that include calling for federal and state-level parity compliance market audits of health plans and improving the availability of mental health care through the following:

  • Increasing reimbursement rates and other incentives for mental health professionals, who earn less than other health professionals
  • Reducing barriers to tele-mental health services for those not geographically close to mental health providers
  • Expanding reimbursement for healthcare models that integrate health, mental health and substance use disorder care
  • Recruiting and contracting with a wider range of providers 
  • Promoting use of advance practice nurses and other health care professionals with appropriate training to prescribe mental health medications

The data is indefensible: the inequities for people seeking mental health care are real and when it comes to what we pay, the bottom line is the bill always comes due in one way or another. Without needed mental health care, we will sadly see the costs include homelessness, incarceration, overdoses and suicides. Lives lost. As leaders, as community members, and as a nation, we need to end this discrimination against people with mental illness and provide them with the care they need and deserve.

Angela Kimball is responsible for overall leadership of NAMI’s mental health policy and advocacy initiatives. NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.