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For Nondiscriminatory Coverage of All Mental Health Treatment

Policy Date: 1/1/1997
Policy Number: 9701

The American Public Health Association,
Being aware that an estimated 40 million Americans have diagnosable mental illnesses including five million with schizophrenia, severe depression, manic-depressive illness, obsessive compulsive disorder and panic disorder;1
Recognizing that well understood and effective interventions and therapies are available for treating individuals with severe mental illness;2
Further acknowledging that people with mental illnesses and substance abuse disorders have experienced significant difficulty in accessing these effective, culturally appropriate treatments owing to discriminatory insurance coverage for mental illness relative to other medical disorders;3
Being cognizant that the costs of treating mental illnesses are comparable to the treatment of other serious and chronic medical conditions;4
Realizing that actuarial estimates and state expenditure experience indicate that the additional costs of non-discriminatory coverage are less than 1% of the base premium;5
Recognizing that approximately 75% of individuals favor non-discriminatory insurance coverage for mental illnesses;6
Acknowledging that important guidance in implementing the Americans with Disabilities Act has recently been promulgated by the Equal Employment Opportunity Commission (EEOC);7
Realizing that rapid movement to managed care in state Medicaid mental health systems may further disadvantage individuals with mental disorders;8
Further recognizing that the United States Congress (PL 104-204) and numerous states, including New Hampshire, Rhode Island, Maine, Vermont, Connecticut, Colorado, Maryland, Minnesota, Indiana, Texas, North Carolina, Arizona, Arkansas, South Carolina, and Missouri, have enacted legislation that seeks to improve parity in insurance benefits for mental illnesses relative to other medical disorders and more than 30 states are considering such legislation;9
Concluding that non-discriminatory coverage for mental disorders is merited by our understanding of the etiology and treatment of these disorders, is an affordable public policy alternative and may importantly reduce the individual disability as well as the family and public welfare burden created by inadequate access to effective treatments; therefore
Urges federal, state, and local government to enact legislation and promulgate policy designed to insure parity of insurance benefits for individuals with mental illnesses including substance abuse;
Asks that the National Institutes of Health (NIH), Health Care Finance Administration (HCFA) and the Agency for Health Care Policy Research (HCPR) underwrite research to better understand the effects of insurance benefit design and benefit management on the non-discriminatory and effective treatment of individuals with mental illness;
Encourages corporate purchasers of health care including self-insured employers to provide industry leadership by requiring parity in coverage for mental illnesses in their employee benefits. These services should strive to be culturally and ethnically competent; and
Endorses the efforts consistent with this policy of other public health and advocacy organizations that seek to address the historical discrimination against persons with mental illness in insurance coverage.

References


  1. Mental Health and Substance Abuse Coverage Under Health Reform, Health Affairs. 1994;13(1):192-205.

  2. Health Care Reform for Americans with Severe Mental Illnesses: Report of the National Advisory Mental Health Council, Department of Health and Human Services, National Institutes of Health, NIMH, March, 1993.

  3. Examples of Insurance Discrimination, National Alliance for the Mentally Ill. 1996. A Mental Health Capitation Program: Patient Outcomes, Hospital and Psychiatry, 1994;45:1090-1096.

  4. Project Hope, Tami Mark: "Estimates of the Cost of Purity for Biologically-Based Mental Illnesses." April 30, 1996. A Guide to Implementing Parity for Mental Illness: Case Studies. William M. Mercer, Inc., June, 1997.

  5. Parity in Coverage of Mental Health Services in an Era of Managed Care: An Interim Report to Congress by the National Advisory Mental Health Council, Rockville, MD, National Institutes of Health, 1997.

  6. Opinion Research Corporation, Public Opinion Poll on Parity: A Full Report, Princeton, New Jersey, 1997.

  7. "Work Rules Stir Debate on Mental Illness." USA Today, 4-B, May 21, 1997.

  8. Parity in Coverage of Mental Health Services in an Era of Managed Care. U.S. Department of Health and Human Services. National Institutes of Health. NIMH. April, l997.

  9. Campaign Spotlight. Vol. 1, No. 2. National Alliance for the Mentally Ill, 1997.

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