It is a sad reality that mental health disorders are sometimes not taken as seriously as physical ailments. There has long been a stigma against recognizing mental health concerns as a legitimate form of distress, with Psychology Today explaining that people who are afflicted by such disorders often experience prejudice and discrimination from those who do not understand the ramifications of such diagnoses. Fortunately, legislation like the Mental Health Parity Act have turned the clock forward on how insurers treat workers who suffer from mental health issues.
Why is this crucial? Before this legislation, insurers were not required to cover mental health care as part of their group plans. This is because, as the New England Journal of Medicine explains, there has historically been a separation of mental health and addiction treatment from the rest of medicine. This dissonance may have been a contributing factor to the stigma that mental health patients have traditionally received, as mentioned above. As a result of this void, access to much-needed treatment was restricted, meaning patients and their families had to pay out-of-pocket in order to secure treatment.
According to the National Alliance on Mental Illness, the original legislation (signed into law by President Bill Clinton in 1996) offered no provision for covering substance abuse or chemical dependency issues. In 2008, President George W. Bush signed the Act as we know it today, whereby substance abuse disorders receive equal limitations as medical/surgical benefits.
Why did the original Mental Health Parity Act have to be expanded? Not only did it not offer any coverage for substance abuse issues, it also had a number of loopholes that employers and insurers used to get out of standardizing plans. For example, plans could be limited to merely 10 therapy visits for a case of major depression (even though it can be a lifelong illness for many people, according to the Journal of Clinical Depression), and insurers could demand a higher copayment in the case of an outpatient appointment for mental health care than for an outpatient visit for treatment of a physical issue, without violating the law as it was written.
The expansion of the Mental Health Parity Act into the Mental Health Parity and Addiction Equity Act closes the loophole.
Such exploitation was (and remains, to a lesser degree) possible because not many Americans are aware that their mental health rights are protected by law. As recently as 2014, a survey conducted by the American Psychological Association found that only four percent of Americans even know that the Mental Health Parity and Addiction Equity Act exists, even though 27 percent of the population have received mental health care treatment at least once in their lives. Mental health issues are the causes of disability in North America, with more than 41 million people in the US alone believed to be suffering from some form of mental illness.
Quoting figures from the Substance Abuse and Mental Health Services Administration, the American Psychological Association noted than nearly 11 million Americans have mental health care needs that are not currently being met, underscoring the necessity of legislation like the Mental Health Parity and Addiction Equity Act.
Encouragingly, the MHPAEA covers all the mental health and substance abuse disorders covered by a health plan; however, in the interests of fairness to insurers, health plans are allowed to specifically exclude certain diagnoses from their coverage (either from the medical/surgical spectrum or the mental/substance abuse spectrum). Exclusions have to be made clear in the documentation provided by the insurance company.
Together with the Affordable Care Act of 2010, the Mental Health Parity and Addiction Equity Act has helped 60 million Americans who needed behavioral health benefits, says the Substance Abuse and Mental Health Services Administration. It has also created programs whereby local entities – states and communities – can provide education about mental health care issues, in terms of how to prevent harmful mental health environments and how to promote positive ones.
Writing about the reach of the ACA and the MHPAEA, the Journal of Behavioral Health Services & Research posited that coverage of mental and behavioral health care will be expanded by “historic proportions.”
In 2013, the Departments of Health and Human Services, Labor and the Treasury issued a joint “final rule” on the MHPAEA, clarifying additional protections for consumers, such as:
With this, the US government hopes to complete their plan to make insurance coverage for people suffering from co-occurring mental health and substance abuse disorders as comprehensive as possible, while simultaneously closing the gap between the treatment and perception of mental illness and other forms of medical distress.
As laid out by Kathleen Sebelius, the Secretary of Health and Human Services, in her statement announcing the final ruling, the goal of the Mental Health Parity and Addiction Equity Act is to make mental health and substance abuse treatment services affordable and accessible to all Americans.
 “The Mental Health Parity and Equality Addiction Act.” (n.d.) Centers for Medicare and Medicaid Services. Accessed April 16, 2015.
 “Preventing Recurrent Depression: Long-Term Treatment for Major Depressive Disorder.” (2007). Journal of Clinical Psychiatry. Accessed April 16, 2015.
 “Few Americans Aware of their Rights for Mental Health Coverage.” (May 2014). American Psychological Association. Accessed April 16, 2015.
 “How the Affordable Healthcare Act and the Mental Health Parity and Addiction Equity Act Greatly Expand Coverage of Behavioral Health Care.” (October 2014). Journal of Behavioral Health Services & Research. Accessed April 16, 2015.
 “Administration Issues Final Mental Health and Substance Abuse Disorder Parity Rule.” (November 2013). U.S. Department of Health and Human Services. Accessed April 16, 2015.
Integrated Treatment of Substance Abuse & Mental Illness