Behavioral health has long been the step child of health care, but the tide is starting to turn. Behavioral health services are on the rise. More and more people are gaining access. National cases are casting a new light on the need for strong mental health providers. New coordinated care models are encouraging a look at the total patient—both mind and body. Yet there is still work to be done. There are still social stigmas connected to behavioral or mental health conditions. States continue to cut funding for mental health programs. It will take time and education, but still the tide is turning for mental health.
On par with physical health
In October 2008, George W. Bush signed The Mental Health Parity and Addiction Equity Act into law. The act was designed to prevent insurance companies from placing different rules around physical health than they did for mental health. For example, if there was no limit on the amount of doctor’s visits you could have to treat cancer, there couldn’t be limits set to treat depression. Mental health coverage had to be comparable to physical health coverage. Changes in plans were slow to occur however until the Affordable Care Act (ACA) was put into effect. The ACA gave mental health access its first real boost since the parity act.
The ACA provides additional safety nets
The Affordable Care Act included the parity act, but went further to help people get the mental health care they need. First, mental illness is often a chronic condition that doesn’t go away. Before the ACA was put in place, people with mental health problems could easily be denied coverage. It’s not so now. The ACA capped out-of-pocket expenses at just over $6000 for individuals, which will be a tremendous support to those with mental health issues. For example, a 90-day in-patient treatment for substance abuse can easily reach $25,000 and was simply out of reach for many people before the ACA. Prescription drugs are now covered in varying capacities that may or may not have been covered pre-ACA. But what the ACA really did was get more people insured than ever before.
More with access for those at risk
Both the state and federal health care marketplaces certainly have extended coverage to those who were not able to afford it without the help of subsidies. However, the expansion of Medicaid also provided patients with access to behavioral health services who otherwise went uncovered. Those on or near the poverty line tend to be at higher risk for needed services. In addition, CNBC reports that half of all mental health and substance abuse begins before high school and 75 percent develop before age 24. Thus the ACA’s provision that children under-26 can remain on their parents’ policies likewise extended coverage to an at-risk population.
Demand straining services
All in all, 62.5 million Americans are expected to gain access for the first time or receive better access to mental health and substance abuse services through the ACA. Yet, it comes at a time when services are already strained due to a series of cuts that occurred for mental health from 2009 to 2012. According to US News and World Report, states had cut mental health budgets by a collective $4.35 billion. With it, went more than 3,222 psychiatric beds. And while funding increased in 2013 after the wake of the Sandy Hook shootings where Adam Lanza’s mental condition went untreated, progress has slowed according to a statement provided by Mary Giliberti, executive director of NAMI (National Alliance of Mental Illness). There is clearly work to be done.
Behavioral health and substance treatment visits account for almost a third of the 56 million rides LogistiCare conducts. We anticipate that those figures will only rise. Demand for mental health counselors and psychiatrists is increasing. Coordinated care strategies are being designed to make access easier and general practitioners are stepping up to help identify early warning signs to make sure those who need it, seek treatment. While it will take time, education and awareness, the tide is turning to give behavioral health equal footing in health care. Long overdue.