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Available and Affordable Mental Healthcare

Oldham, John, MD

Journal of Psychiatric Practice®: November 2013 - Volume 19 - Issue 6 - p 441
doi: 10.1097/01.pra.0000438182.36241.1f


November, 2013. As the November issue of the Journal goes to press, the Obama Administration has just issued its Final Rule on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Although the 2008 Parity Law mandated that employer-based health plans that provide coverage for mental and substance use disorders must provide benefits similar to those provided for medical/surgical conditions, it did not require employers to cover mental or substance use disorders. The Final Rule just issued clarifies that, in 2014, the Affordable Care Act will require all new plans, including individual and small group plans, to offer coverage for mental health and substance use disorders, at parity, as a core benefit. In addition, plans that include inter- mediate levels of care for medical/surgical conditions must provide the same level of care for mental and sub- stance use disorders. Overall, this development is an important step forward in the long struggle to eliminate stigma and discrimination. The fact that governmental mandates are necessary to equalize the reimburse- ment rules of health plans underscores the stubborn pervasiveness of the incorrect belief that disorders of the brain are fundamentally different from disorders of the rest of the body. In that regard, the Final Rule is a powerful step forward.

In this issue of the Journal, Battle and colleagues focus on the importance of evidence-based, quality treat- ment of depression for women in the perinatal period. They point out that clinicians providing prenatal care often do not discuss symptoms of depression with their patients, perhaps reflecting either their own discom- fort with the subject or their uneasiness that their patients will not welcome the discussion, or both. They focus on patient-centered care involving patient education and decision-making, to reverse the unfortunate state of affairs that the majority of women who become depressed in the perinatal period do not receive treat- ment. It is likely that, in addition to the many reasons for this problem discussed by Battle and colleagues, treatment may not have been available or affordable due to inequities supporting mental health treatment.

Also in this issue, Hower and co-workers report a steady decline with age in mental health treatment for youth with bipolar disorder, unrelated to symptom severity or impairment. Among the factors accounting for this trend, the authors cite the cost of treatment and restrictive payer limits on the number of reimbursable family sessions. These reports are only two of many in the literature that have documented inequities in our healthcare system regarding mental health treatment, in spite of the progress made by the 2008 Parity Act. We can all hope that these new federal rules will close some of the loopholes that have persisted, so that true equity for mental health can be accomplished in full.

John Oldham, MD


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