Now Published: The Benefit of Mental Health Benefit Laws

Low or no health insurance coverage for mental health services may prevent some people who need mental health treatment from getting it (U.S. Department of Health and Human Services, 1999).The Community Preventive Services Task Force (Task Force) has published the following population-based recommendation to increase access to and appropriate use of mental health services:

The Community Preventive Services Task Force recommends mental health benefits legislation, particularly comprehensive parity legislation, based on sufficient evidence of effectiveness in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. There is also evidence that mental health benefits legislation is associated with increased access to care, increased diagnosis of mental health conditions, reduced prevalence of poor mental health and reduced suicide rates.

A concurrent economic review indicates that mental health benefits expansion did not lead to any substantial increase in cost to health insurance plans, measured as a percentage of premiums.

The Task Force notes that appropriate use of mental health services includes receiving:

• The proper amount and quality of mental health care by people in need
• Services that are provided by mental health specialists, such as a psychiatrist, psychologist or social worker
• Care that is consistent with evidence-based guidelines for mental health care and substance abuse

The following articles about benefits legislation to improve mental health appear in the June 2015 issue of the American Journal of Preventive Medicine:

• Evidence review Sipe TA, Finnie RKC, Knopf JA, Qu S, Reynolds JA, Thota AB, Hahn RA, Goetzel RZ, Hennessy KD, McKnight-Eily LR, Chapman DP, Anderson CW, Azrin S, Abraido-Lanza AF, Gelenberg AJ, Vernon-Smiley ME, Nease DE, Community Preventive Services Task Force. Effects of mental health benefits legislation: a Community Guide systematic review. American Journal of Preventive Medicine 2015;48(6):755-66.
• Task Force recommendation Community Preventive Services Task Force. Recommendation for mental health benefits legislation [PDF – 137 kB]. American Journal of Preventive Medicine 2015;48(6):767-70.

The full-text article for the systematic review of economic evidence also is available:

• Economic review – Jacob V, Qu S, Chattopadhyay S, Sipe TA, Knopf JA, Goetzel RZ, Finnie R, Thota AB, and the Community Preventive Services Task Force. Legislations and policies to expand mental health and substance abuse benefits in health insurance plans: a Community Guide systematic economic review [PDF – 301 kB]. Journal of Mental Health Policy and Economics 2015; 18(1):39-48.

The Task Force’s recommendation is based on a systematic review of the literature that was conducted by scientists from the Centers for Disease Control and Prevention (CDC). The review was carried out with Task Force oversight, in collaboration with a wide range of government, academic, policy, and practice-based partners.

What is meant by “mental health benefits legislation”?

This review considered legislation and executive orders enacted at the state or federal level.

• Parity in this review means having no greater restrictions for mental health coverage than for physical health coverage (Employee Benefits Security Administration, 2010). Parity laws may range from limited to comprehensive.
  • Comprehensive laws require insurance coverage for a broad range of mental health and substance abuse disorders, and place no greater restrictions on benefits (e.g., visit limits, treatment limits, annual dollar limits or deductibles) for mental health services than benefits for physical health services.
  • Limited parity may cover specific mental health conditions, including substance abuse, or allow more restrictions in benefits compared to physical health (e.g., visit limits, copayments, deductibles, annual and lifetime limits).
  • Comprehensive parity covers a broad range of mental health conditions, including substance abuse, with few or no restrictions.
• Mandate laws may or may not be parity laws. These laws require insurers or health insurance plans to do at least one of the following:
  • Provide some specified level of mental health coverage, or in cases when mental health insurance was already being provided, meet a minimum benefits level.
  • Offer the option of mental health coverage.
• Executive orders for mental health parity for government employees may be issued at the federal or state level.

Why is the Task Force recommendation important?

• Nearly 1 in 5 U.S. adults reported a diagnosable mental illness in 2013 (Substance Abuse and Mental Health Services Administration, 2014) and nearly half will experience at least one during their lifetime (CDC 2011; Kessler et al. 2004, 2005, 2005).
• A U.S. Surgeon General’s report estimates that mental illness is the second largest contributor to disease burden in established market economies such as the United States (U.S. Department of Health and Human Services 1999).
• The cost of mental health care in the U.S. was estimated to be $77.6 billion in 2011, the fourth highest medical expense following heart conditions, cancer and trauma (Kessler et al., 2008).
• Just over 45 percent of adults with a mental illness received no mental health services in the previous year (Substance Abuse and Mental Health Services Administration 2014).

What are the Task Force and Community Guide?

• The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, uncompensated panel of public health and prevention experts. The Task Force works to improve the health of all Americans by providing evidence-based recommendations about community preventive programs, services, and policies to improve health. Its members represent a broad range of research, practice, and policy expertise in community prevention services, public health, health promotion, and disease prevention.
• The Guide to Community Preventive Services (The Community Guide) is a website that is a collection of all the evidence-based findings and recommendations of the Community Preventive Services Task Force.
• The Centers for Disease Control and Prevention (CDC) is mandated by the U.S. Congress to provide ongoing administrative, research, and technical support for the operations of the Task Force. CDC is therefore committed to working with the Task Force to systematically review the scientific evidence on population-based strategies to reduce the burden of preventable disease, injury, and disability.

For More Information

• The Community Guide Improving Mental Health and Addressing Mental Illness
• CDC, Mental Health

References

CDC. Mental illness surveillance among adults in the United States. MMWR 2011;60(Suppl):1-32.

Employee Benefits Security Administration. Fact Sheet: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Washington (DC): United States Department of Labor. 2010. Available at URL: https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/mhpaea.pdf. Cited: 4/17/15.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry 2005;62(6):593-602.

Kessler RC, Chiu WT, Colpe L, Demler O, Merikangas KR, Walters EE, Wang PS. The prevalence and correlates of serious mental illness (SMI) in the National Comorbidity Survey Replication (NCS-R). In: Manderscheid RW, Berry JT, editors. Mental Health, United States, 2004. DHHS Pub No. (SMA) 06-4195. Rockville (MD): Center for Mental Health Services, Substance Abuse and Mental Health Services Administration;2004:134-48. Cited: 4/17/15.

Kessler RC, Chiu WT, Demler O, Merikangas KR, Walter EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psych 2005;62:617-27.

Kessler, RC, Heeringa S, Lakoma MD, Petukhova M, Rupp AE, Schoenbaum M, Wang PS, Zaslavsky AM. The individual-level and societal-level effects of mental disorders on earnings in the United States: results from the National Comorbidity Survey replication. Am J Psy 2008;165:703-11.

Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-49, HHS Publication No. (SMA) 14-4887. Rockville (MD): Substance Abuse and Mental Helath Services Administration; 2014. Available at URL: http://www.samhsa.gov/data/sites/default/files/NSDUHmhfr2013/NSDUHmhfr2013.pdf. Cited: 4/17/15.

U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. Available at URL: . Cited: 4/17/15.