Running head: MENTAL HEALTH PARITY POLICY ACTION PLAN 1

Mental Health Parity Policy Action Plan

Amanda Scott

Delaware Technical Community College

Nursing Policy

Kristin Doughty

April 19, 2021

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Mental Health Parity

People struggling with mental illness are not always treated fairly. Not only can

finding quality care be difficult based on providers accepting insurance plans, but it can

also be financially difficult to obtain, as insurance companies have not always placed the

same standards on mental health treatment as they have for physical illness. Mental health

parity can be described as treating mental health illnesses and substance abuse disorders as

equally as chronic physical illnesses, such has heart failure or diabetes (National Alliance,

n.d.). Mental health parity has not always been a reality. Insurance companies would, in

the past, place limits on mental health and substance abuse coverage, requiring more out-

of-pocket expenses and limiting visits for their insured (Mason et al., 2015).

Fairness for the Insured

Having parity within an insurance plan means that provided coverage for general

medical and surgical care, including the deductibles, copays, inpatient stays, outpatient

services, and limits on treatment must be comparable for mental health and substance

abuse care, but it does not mean that an insurance company must provide mental health

and substance use coverage if it does not already do so (Mason et al., 2015). It stands to

reason that by eliminating limits on coverage for mental health illnesses and substance

abuse disorders, costs for insurance companies would rise to an unmanageable amount,

and this was a concern of the insurance providers (Mason et al., 2015).

One insurance company, TRICARE (a health care program for U.S Armed Forces

military members, retirees, and their dependents), saw an approximate $19 million dollar

increase when adding different levels of care, more providers, and types of mental health

care, and to offset this, they would use lower and less expensive level of care, such as an
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intensive outpatient program versus partial hospital program versus residential program

(Department of Defense, 2016). Parity unfortunately does not ensure the best medical

coverage. It only requires that coverage be equal, so if the medical portion of the plan is

limited, the mental health portion will also be limited (National Alliance, n.d.).

Laws Relating to Mental Health Parity

Thanks to federal laws such as the Mental Health Parity Act and the Mental Health

Parity Addiction Equity Act and state laws such as Delaware’s Mental Health Parity of 2018

(Senate Bill/SB 230), members of the government at state and federal levels are working to

eliminate barriers, remove the stigma associated with mental health illness, and make

mental health treatment fair for all. Generally, each of these laws stop health insurance

companies that provide mental health or substance abuse disorder coverage from imposing

less favorable benefit limitations on those benefits than they do on medical benefits. Prior

to these legislative acts, insurance companies did not have to provide equal benefits to.

Key Stakeholders in Mental Health Parity

It is important to contact key stakeholders when in pursuit of implementing legislature.

These people or groups will have interests in the process, amending proposals, and the

implementation. Within the state, the Governor is an important official to speak with, like

Delaware Governor John Carney, as they would have some influence. Members of Congress

who would have influence and say in law-making and would be important to contact in

discussing the importance of legislation would be people like Delaware Senators Christopher

Coons and Thomas Carper and House of Representative member Lisa Blunt Rochester. By

contacting government officials, one would hope to persuade them to take a stance on

legislation or policy or to vote a specific way.

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The American Nurses Association and state chapters would be able to assist in lobbying

and advocating for legislature that is beneficial to nursing and healthcare. Gaining the help of

the State Insurance Commissioner would be beneficial, because in some cases, like in

Delaware, they play a key role. Insurance Commissioner Trinidad Navarro announced that

the Delaware Department of Insurance found thousands of violations of the laws that ban the

discrimination against mental health and substance use disorders, as recently as November of

2020 (Delaware.gov, 2020). Violations were expected, as this was the first assessment since

the passage of SB230, but the assessment also identified the problematic areas and brought

about discussions on how to improve the parity (Delaware.gov, 2020). Parity is only

meaningful if insurance companies are actually applying the mental health parity laws to

their plans.

Controlling costs and compliance by the insurance companies to the mental health parity

laws must be addressed on a federal level as well, to ensure that the insured are being treated

fairly when it comes to mental health parity. The Centers for Medicare and Medicaid issued

the Medicaid Mental Health Parity Final Rule in 2016 for Medicaid recipients; the objective

was to build uniformity between commercial and Medicaid markets (Department of Health,

2021). Importantly, at the end of 2020, Congress passed the Strengthening Behavioral Health

Parity Act (H.R. 7539), which gives the Department of Labor the authority to monitor,

regulate, and audit insurance plans to be sure they are compliant with the 2008 Mental Health

Parity and Addiction Equity Act (American Psychiatric Association, 2020).

Lobbying for Mental Health Parity

When planning to lobby for support for mental health parity, one may want to find and

connect with others who are like-minded on the issue. This can be done through outlets like
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social media. This ensures support from the ground up and allows there to be a way to plan,

improve upon, and implement what one is hoping to accomplish. When lobbying for support for

mental health parity, it is important to be educated on the supported issue, being able to answer

questions that are posed or at least know where to look for necessary answers.

Political attention needs to be gained. It is also important to be educated on each person

of power and stakeholder’s perspective on mental health parity, such as if they are already in

support of or opposition to it or how they have voted on similar issues. Knowing who one is

speaking to will make for better success. It could also be important to know how mental health

parity laws would affect stakeholders and how it may affect the state or nation. After educating

oneself, the next step would be to speak with legislators either by letter, email, phone, or in

person and be ready to discuss and defend the issue at hand.

Important Talking Points

There are several things that would be of significance to discuss with decision-makers

when hoping to get them to want to advocate, and ultimately vote, for mental health parity. They

will want to base their decision on facts and rationale. Gaining knowledge on the subject at hand

and being ready to answer questions and give valid reasoning will help to influence the

decisions.

The consequences of not having fair treatment for mental health illnesses and substance

abuse disorders is vital to seeking advocacy for mental health parity. Mental health illnesses can

lead to substance abuse, unemployment, homelessness, disrupted family life, violence, and

premature death. Former representative Tim Murphy of PA states, “We have replaced the

hospital bed with the jail cell, the homeless shelter, and the coffin. How is that compassionate?"
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(as cited in Szabo, 2014). Mental health affects every aspect of one’s life. There must be fair

treatments.

By having mental health parity laws enacted, it is essential to discuss public education of

and awareness on the availability of mental health parity. If the general public does not have a

basic understanding of parity, they most likely will not know their rights to mental health parity.

Public health announcements and programs should be enacted to educate on what is available to

them. An easy way to distribute the information is through media outlets.

On the same lines, the stigma behind mental health illness should also be discussed.

Many do not seek help because of this stigma (Schomerus et al., 2018). If the public is educated

on the reality of mental health illness, one would hope that judgements would decrease. Those

needed assistance may be more inclined to seek it out.

Of value to decision-makers may be how mental health parity would affect them and their

state or government, and the financial aspect of an issue is something that typically will trigger

interest. Not only does mental health affect personal well-being, it also affects job productivity as

well, and untreated mental illnesses costs approximately $100 billion a year in lost productivity

(National Alliance, n.d.). This is taxing on the economy. Unless personally touched by mental

health illness, some decision-makers may feel that mental health parity does not involve them.

This would be incorrect thinking. Dr. Thomas Insel is the former Director of the National

Institute for Mental Health. He stated that mental illnesses cost the country approximately $444

billion a year, noting that most of this money goes to disability payments and lost productivity

(Szabo, 2014). It does not include the cost of building prisons or caregivers’ lost earnings. Only

about a third of the $444 billion goes towards medical care for those with mental illness, and
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according to Insel, “The way we pay for mental health today is the most expensive way possible”

(as cited in Szabo, 2014).

Additional funding may also be of interest. Within the Strengthening Behavioral Parity

Act package, significant funding was allocated to other mental policies and programs. The

Substance Abuse and Mental Health Services Administration’s Minority Fellowship Program

received $16.2 million, while Mental Health Crisis Care received $35 million, and the Substance

Abuse and Mental Health Services Administration received a budget of $6 billion, which was a

$133 million increase over the previous fiscal year (O’Conner, 2021). Allocation of funding

allows effective, evidence-based care. The impact on healthcare if mental health illnesses and

substance use disorders lost funding to improve upon, implement, and continue care would be

devasting.

Mental health illness affects many areas, even when one does not realize their life is

being affected. By discussing several, well-rounded topics related to mental health, decision-

makers can have the necessary information to make the most beneficial choice possible. The

negative effects of not having parity within mental health care must be realized.

90-Day Action Plan and Implementation

Within the first 90 days of setting a plan to action, one would first want to reach out to

like-minded individuals who also want to lobby for mental health parity. Social media could be

used to make one’s voice heard, to spread the word on mental health parity and its importance,

and to connect with individuals interested in change. It is then important to reach out to local,

state, and national legislators to discuss mental health parity and voice why action on the issue is

crucial. Have as much information on hand as possible to explain why they should advocate for

mental health parity. It may be beneficial to attend any town hall meetings or public event held
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by legislators. Including the media could be beneficial to get the word out about mental health

parity and to encourage others to also get involved and contact legislators. Afterwards, be sure to

follow up with those that were spoken to and be prepared to re-educate and reiterate.

Mental Health Parity Action Plan Goals & Outcome

The impact on healthcare if mental health illnesses and substance use disorders could not

be improved upon and covered would be devasting. By not having access to fair insurance

policies, people may not get the help they need. It can be difficult to find mental health

providers who are in-network and take certain insurances. The difficulty would be harder if

there is not fair coverage. Overdose deaths would increase, suicides would increase, along

with drug abuse in general, and families would be torn apart by mental health illnesses and

substance abuse, particularly if no coverage is available.

The insured need fair access to evidence-based services that are covered by their plans.

Evidence-based services bring the best researched practices for improved patient care,

including crisis care services, like call centers, mobile crisis services, or stabilization units

(O’Conner, 2021). There would be no one to turn to in an emergency, especially in times like

the current COVID-19 pandemic, which is taxing on mental health. If insurance providers

offer fair coverage, clients will be able to access many different mental health providers.

Providers are not a one-size-fits-all. Finding the correct provider who can provide the correct

care and the tools needed to succeed are important.

Conclusion

Mental health affects so many parts of one’s life. It is weaved into family life, jobs,

day-to-day living. Mental health is a vital part of life. One cannot have overall good health
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without having good mental health, and good mental health care cannot be accessed without

fair, appropriate coverage.

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References

American Psychiatric Association. (2020, December 22). APA applauds congress for taking

action to strengthen mental health parity including key mental health programs in year-

end funding package. https://www.psychiatry.org/newsroom/news-releases/apa-applauds-

congress-for-taking-action-to-strengthen-mental-health-parity-including-key-mental-

health-programs-in-year-end-funding-package

Delaware.gov. (2020, November 19). Delaware’s first mental health parity examinations

complete. https://news.delaware.gov/2020/11/19/delawares-first-mental-health-parity-

examinations-complete/

Department of Defense. (2016, September 2). TRICARE: Mental health and substance use

disorder treatment. https://www.federalregister.gov/d/2016-21125

Department of Health Care Services. (2021, March 23). Mental health parity. https://www.dhcs.

ca.gov/formsandpubs/Pages/MentalHealthParity.aspx#:~:text=On%20March%2029%2C

%202016%2C%20the%20Centers%20for%20Medicare,create%20consistency

%20between%20the%20commercial%20and%20Medicaid%20markets.

Mason, D., Gardner, D., Outlaw, F.H., & O’Grady, E. (2015, May 14). Policy & politics in

nursing and healthcare. St. Louis, MO: Elsevier.

National Alliance on Mental Health. (n.d.). What is mental health parity. https://www.nami.org/

Your-Journey/Individuals-with-Mental-Illness/Understanding-Health-Insurance/What-is-

Mental-Health-Parity#:~:text=Mental%20health%20parity% 20describes%20the%20

equal%20treatment%20of,conditions%20and%20substance%20use%20disorders%20in

%20insurance%20plans
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O’Conner, K. (2021, February 24). Congress passes parity, increases some mh funding.

https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2021.3.5

Schomerus, G., Stolzenburg, S., Greitag, S., Speerforck, S., Janowitz, D., Evans-Lacko, S.,

Muehlan, H., & Schmidt, S. (2018, April 20). The negative effects of not having parity

within mental health care must be realized. European Archives of Psychiatry and Clinical

Neuroscience. 269(4), 469-479. doi: 10.1007/s00406-018-0896-0

Szabo, Liz. (2014, May 12). The cost of not caring: Nowhere to go. https://www.usatoday.com/

story/news/nation/2014/05/12/mental-health-system-crisis/7746535/