Running head: MENTAL HEALTH PARITY 1

Mental Health Parity Action Plan

Melissa Towe

Delaware Technical Community College

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Mental Health Parity Action Plan

The lack of mental health parity is a serious problem in the United States and has been

for many years. In order to fully understand why mental health parity is lacking, it’s important

to understand what parity means. Parity in its most simple form means equality. In regards to

mental health, it means equal treatment, access to care, and insurance coverage.

Unfortunately, even a brief overview of the current health care status will prove that we are

far from achieving true parity for our mental health population. Those who know the mental

health care system best, psychiatrists and behavioral health specialists, describe the state of

mental health care in America as three things: “Broken. Grossly underfunded. In crisis”

(Hoppel, 2015, p. 36). “The problems that plague the health care system in general-workforce

shortages, barriers to access, and inadequate reimbursement- are only exacerbated in mental

health” (Hoppel, 2015, p. 36). Additionally, the mental health population is difficult to reach.

Many people with severe mental health disorders are jobless, homeless, and/or uninsured. To

best understand the importance of reaching parity for this population, it’s necessary to

understand what the mental health population looks like.

Identification of the Problem

The mental health population is an extremely large and vulnerable population. The

disorders frequently observed in this population often include: bipolar, schizophrenia,

depression, anxiety, post-traumatic stress disorder, eating disorders, attention deficit

disorders, post-partum depression, and even Alzheimer’s. Mental health disorders also

encompass substance use disorders, and both are directly linked to increased risk of

homelessness, criminal activity/incarceration, medical problems, and suicide (Substance

Abuse and Mental Health Services Administrations [SAMHSA], 2016). When substance use
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and mental health disorders occur in the same person, this is termed a co-occurring disorder

(Center for Behavioral Health Statistics and Quality [CBHSQ], 2015). In 2014, 7.9 million

American adults had co-occurring disorders (CBHSQ, 2015). Co-occurring disorders make a

significant contribution to the burden of disease in America by adding to the number of

inpatient hospitalizations, days of missed work and school, diminishing personal productivity,

and the increasing problems related to criminal activity (CBHSQ, 2015). Mental health

illnesses affect people of all ages, races, religions, socioeconomic statuses, and the list goes

on. The percentage of people with mental health illnesses continues to rise which sheds light

on the importance of providing adequate health care to this population.

The barriers to the accessibility of mental health care all center from the lack of parity.

There is a shortage of providers, often associated with the issues in receiving payment from

insurance. This often leads to primary care doctors treating mental health disorders when

patients could benefit from referrals to psychiatric providers. However, due to the shortage of

mental health providers, there often isn’t anyone to refer them to, and if there is, the waiting

lists are long (Hoppel, 2015). When mental health providers are available, financing the care

becomes the next barrier. Arguably the biggest disparity for this population is the lack of

mental health parity (Hoppel, 2015). Mental health benefits often differ from those of physical

health, “What services are covered and at what rate tends to vary by state, and… is often not

covered at the same rate as physical health” (Hoppel, 2015, p. 39). This is a huge barrier to

care for this population as insurance companies can deny coverage for mental health

conditions, which can cause equally severe problems as physical health conditions.

Key stakeholders
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In order to make a difference in advocating for mental health parity, you have to know

who to contact. I am currently living in Delaware, so I chose to start with Delaware Health

and Social Services (DHSS), specifically, the Division of Substance Abuse and Mental Health

(DSAMH). Elizabeth Romero is the director of DSAMH and Cara Sawyer is the deputy

director. Both have listed phone and fax numbers listed on the DSAMH website (Division of

Health and Social Services [DHSS], 2019). DSAMH plays a very large role in the

organization and funding of the mental health resources and programs available in Delaware.

They make a good choice of stakeholders as they are actively involved in the distribution of

funds and services for this population.

The Mental Health America’s Regional Policy Council also works to “…initiate,

advocate for, and implement federal and state policies that positively affect children, youth,

and adults living with mental health and substance use conditions” (Mental Health America

[MHA], 2019, para. 1). The director of advocacy who represents the state of Delaware is

Barbara Johnston and her contact information is available on the Mental Health America’s

website.

The National Alliance on Mental Health (NAMI) is probably one of the most well-

known stakeholders in the mental health field. NAMI has provided grants for research,

funding, housing and community support for members with mental health illnesses. Dr.

Joshua Thomas is the executive director for Delaware’s branch of NAMI (National Alliance

on Mental Illness [NAMI], 2019). I would also attempt to reach out to Governor John Carney

as he has been known to support mental health and has signed into law the mental health

parity act.

Current Mental Health Laws

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One of the most notable mental health laws at present is the Mental health parity and

addiction equity act (MHPAEA) of 2008. This act had a goal to achieve parity for the mental

health population. The MHPAEA established equal benefits by requiring insurance companies

to provide mental health benefits that equaled the benefits they offered for physical health

(Centers for Medicare & Medicaid Services [CMS], n.d.). Unfortunately, this act fell short in

achieving true parity in insurance for mental health. Insurance companies were required to be

equal in their restrictions, limitations, copays, and days covered, for both the physical and

mental health aspects of their health plans (CMS, n.d). However, the insurance companies

were not required to offer mental health coverage in the first place. The MHPAEA only stated

that if the health plan offered mental health benefits, it must be equal to the benefits offered

for physical health (CMS, n.d.). This created a loophole for smaller insurance companies to

continue to leave mental health benefits out of their plans completely. The MHPAEA did

however make strides towards parity. It ascertained that mental health plans did not impose

more restrictive or less favorable limits on their mental health plans, thus providing the

mental health population with more equal coverage and improved access to care.

Senate Bill 41 was another law that improved mental health parity. The goal for Senate

Bill 41 was to amend Title 18 of the Delaware Code in regards to its mental health coverage

for drug and alcohol dependency (DGA, n.d.). Simply stated, Senate Bill 41 required

insurance providers to cover in patient substance abuse treatment when medically necessary,

while eliminating the process of “precertification, prior authorization, pre-admission

screening, or referral requirements” (S. 41, 2017). In relation to the mental health field,

specifically the population with drug and alcohol use disorders, insurance companies can

cause delays in access to care by requiring pre-certifications, prior-authorizations, screenings,

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and referrals (DGA, n.d.). The ultimate goal of Senate Bill 41 was to eliminate these delays in

care and attempt to provide coverage for the treatment of substance use disorders (DGA, n.d.).

Senate Bill 41 allows patients to receive immediate access to care. Per Senate Bill 41, patients

receive an automatic 14 days of inpatient treatment for substance use disorders before the

insurance company does a utilization review to determine if further stay is medically

necessary (S. 41, 2017).

Strategies for implementing change and discussion points

In order to implement change in the mental health field, it’s important to know where

to start. I would begin by advocating mental health coverage across all insurance plans. I

would seek out the above mentioned key stakeholders and become active in their

organizations by reaching out through both letter and phone. I would become involved in the

things that their organizations are currently advocating for as I recognize that any

improvement in this population counts. I would also develop a few key points to discuss when

talking to these stakeholders. I would begin by phrasing them as questions, to determine if

these stakeholders already have plans in place for the changes I would like to implement. For

starters, I would discuss parity in Delaware and what steps are being taken to ensure that

patients are educated on their benefits and rights. I would advocate for ways to improve the

educational material available for this population. I would discuss the severe need for

additional community resources and question how we can maximize government funding to

provide these resources. I would question what is currently being done to advocate for this

population and what we could potentially do better. Finally, I would question what steps we

can take to push for parity in all insurance companies, and ways that we can help to close the

remaining gap in care for this population as this would

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Goals

In conclusion, my overall goal in this process is to make a difference in the lives of

patients with mental health disorders and contribute towards achieving parity. While that

seems like an unrealistic goal, I prefer to consider it the long-term goal. My short-term goal is

to become actively involved in organizations that advocate for the mental health community. I

will begin to execute this goal by writing a letter to each of the above-named stakeholders in

an attempt to get involved in their current processes. Showing investment and involvement in

their current projects will allow me to meet other stakeholders, giving me a greater platform

to advocate for the changes I would like to see in the future.

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References

Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the

United States: Results from the 2014 National Survey on Drug Use and Health (HHS

Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from https://www.

samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf

Centers for Medicare & Medicaid Services. (n.d). The center for consumer information &

insurance oversight: The mental health parity and addiction equity act. Retrieved from

https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-

protections/mhpaea_factsheet.html

Delaware General Assembly. (n.d.). Senate bill 41. Retrieved from

http://legis.delaware.gov/BillDetail?LegislationId=25518

Division of Health and Social Services (2019). Contact Information. Retrieved from

https://www.dhss.delaware.gov/dhss/main/contacts.htm

Hoppel, A. M. (2015). Healing the Broken Places. Clinician Reviews, 25(5), 36–41. Retrieved

from http://search.ebscohost.com.libproxy.dtcc.edu/login.aspx?Direct

=true&db=a9h&AN=102996074&site=ehost-live

Mental Health America (2019) Regional Policy Council. Retrieved from

http://www.mentalhealthamerica.net/regional-policy-council

National Alliance on Mental Illness (2019). Delaware. Retrieved from

https://www.namidelaware.org/

Senate Bill 41. (2017). 149th Cong.

Substance Abuse and Mental Health Services Administrations. (2016). Co-occurring disorders.

Retrieved from https://www.samhsa.gov/disorders/co-occurring