Mental Health in the United States

Mental Health Professionals

To be considered a “mental health professional,” a person generally must have an M.D., Ph.D. or M.S.W. Some “experts” have an “M.S., P.D.” which means they have a Master’s degree plus 30 credits — but have not earned a Ph.D. These people are generally not considered professionals under the law.

The Encyclopedia of Associations (available as a multi-volume hard cover, on the Gale Directory Library, and on Lexis (ENASSC)) lists many groups of mental health professionals.

US State Laws Mandating or Regulating Mental Health Benefits Resources

Mental health services have been one significant part of medical care for a number of years. However, the costs, coverage and availability of such services have been the object of policy discussions and a variety of state legislation. There is not a general consensus that state government should require coverage for mental health. 46 states currently have some type of enacted law but these laws vary considerably and can be divided roughly into three categories:

1. mental health “parity” or equal coverage laws
2. minimum mandated mental health benefit laws
3. mandated mental health “offering laws”.

Note that some laws apply primarily to “serious mental illness” and may not assure coverage for current circumstances. Many private market health plans include some type of mental health benefits on a voluntary commercial basis, not necessarily required by state or federal laws. Note that grief counseling may not be considered a covered benefit under some state laws, although it may be offered by insurers as part of a standard mental health benefit package. Laws in 21 states include coverage for substance abuse, alcohol or drug addiction. Most laws listed below were enacted prior to 2001.  In 2002 laws were added in Alabama, Colorado, Kentucky, New Hampshire and New Jersey.

In 2003, “barebones” laws allowing exceptions to mandated coverage, were enacted in Colorado, Montana and Texas.   Maineexpanded categories of illnesses covered; Hawaii and Kansas extended dates of existing coverage laws.

In 2005, Washington enacted a full mental health parity law, applying to health insurance, but exempting policies for individuals and small group employers with 50 or fewer employees.  It will take effect in phases between 2006 and 2010.  Oregon also enacted a full parity law that took effect January 1, 2007.

In 2006-07, three additional states passed full parity laws.  New York’s former Gov. George Pataki signed Timothy’s Law, named for a 12-year-old boy who committed suicide in 2001. The law requires that all private insurance policies have the same deductibles, number of office visits, number of inpatient visits and co-payments for mental health disorders as for other illnesses. The statute also requires that private plans provide at least 30 days of inpatient and 20 days of outpatient mental health care per year. In Ohio, outgoing Gov. Bob Taft signed his state’s first mental health parity law (SB 116) on Dec. 29, 2006. The Mental Health Parity Act mandates that coverage provided for seven “biologically based mental illnesses,” such as schizophrenia and bipolar disorder be on par with those for physical conditions.

In July 2007 The North Carolina legislature enacted a maesure covering nine consitions. See “TWO MORE STATES ENACT PARITY LAWS,” State Health Notes, 1/22/07 North Carolina: Mental-health parity clears last hurdle; Legislature is ready to send bill to Easley. – Winston-Salem Journal, 7/13/07.

Federally funded public programs

The state laws noted below generally do not apply to federally funded public programs such as Medicaid, Medicare, the Veterans Administration, etc. Also, “self-funded” health insurance plans, often sponsored by the largest employers, usually are entirely exempt from state regulation because of the federal ERISA law.

Mental Health Parity Laws

Parity, as it relates to mental health and substance abuse, prohibits insurers or health care service plans from discriminating between coverage offered for mental illness, serious mental illness, substance abuse, and other physical disorders and diseases. In short, parity requires insurers to provide the same level of benefits for mental illness, serious mental illness or substance abuse as for other physical disorders and diseases. These benefits include visit limits, deductibles, copayments, and lifetime and annual limits.
Parity laws contain many variables that affect the level of coverage required under the law. Some state parity laws–such as Arkansas’–provide broad coverage for all mental illnesses. Other state parity laws limit the coverage to a specific list of biologically based or serious mental illnesses. The state laws labeled full parity below provide equal benefits, to varying degrees, for the treatment of mental illness, serious mental illness and biologically based mental illness, and may include treatment for substance abuse. There is no federal law on parity (as of November 2007); see background on unsuccessful federal parity legislation below the state table.

Minimum Mandated Benefit Laws

Many state laws require that some level of coverage be provided for mental illness, serious mental illness, substance abuse or a combination thereof. They are not considered full parity because they allow discrepancies in the level of benefits provided between mental illnesses and physical illnesses. These discrepancies can be in the form of different visit limits, copayments, deductibles, and annual and lifetime limits. Some mental health advocates believe these laws offer a compromise to full parity that at least provides some level of care. Others feel that anything other than full parity is discrimination against the mentally ill. Some of these laws specify that copayments and deductibles must be equal to those for physical illness up to the required level of benefits provided. If a law does not specify, the copayment could be as much as 50 percent of the cost of the visit and require a separate deductible to be met before mental health visits will be covered.

Mandated Offering Laws

Mandated offering laws differ from the other two types of laws in that they do not require (or mandate) benefits be provided at all. A mandated offering law can do two things. First, it can require that an option of coverage for mental illness, serious mental illness, substance abuse or a combination thereof, be provided to the insured. This option of coverage can be accepted or rejected and, if accepted, will usually require an additional or higher premium. Second, a mandated offering law can require that if benefits are offered then they must be equal.

See Also

Doctors
Medical Ethics
Medical Materials
Psychologists

Mental Health in the Criminal Justice System

This section covers the topics below related with Mental Health :

Corrections

Inmate Assistance Programs in relation with Mental Health

Mental Health

Juvenile Justice

Health

Mental Health

Victims

Health and Mental Health

Resources

See Also

• Corrections
• Inmate Assistance Programs
• Mental Health
• Juvenile Justice
• Health
• Mental Health
• Victims
• Health and Mental Health