Final Rule Marks Victory for Mental Health Equality

Early in my career, I frequented emergency departments as a mental health crisis clinician. It might seem like semantics, but I was surprised by how often medical staff referenced "medical patients" and "psych patients" distinctly, almost as if psychiatry were not a branch of medicine.

I have been equally struck by how health coverage sometimes seems to draw a division between the two in ways such as pushing back coverage of intensive care treatment for a suicide attempt because it was "self-inflicted" rather than recognition of the health condition and accompanying emotional pain leading to this.

A person is more than a patient. Yet, in medical settings, most of us are reduced to what brings us to the healthcare setting. At that point in time, we are at the mercy of the health providers with whom we interact within the patient-provider relationship. We are patients.

A Victory

Yet, September 9th, 2024, marked a historic victory for mental health care as President Biden announced a final rule strengthening the provisions of the 2008 Mental Health Parity and Addiction Equality Act (The White House, 2024). This decision will essentially require insurance to cover mental health services equally to physical health services without differentiation by repairing cracks that had previously allowed insurance to skirt some of the spirit of the original act.

This means that more critical oversight will be given to the use of policies such as a requirement of prior approval for mental health services and medications ensuring that the obstacles are set no higher than approvals necessary for other health services. It also expands what healthcare providers will be subject to the Mental Health Parity and Addiction Equality Act affecting an estimated 200 health plans in the country.

Finally, the update will mandate that health insurance offers available and accessible treatment options. To do this, health insurance companies may need to expand their networks of in-network providers or be more compatible with mental health providers.

A recent expose published in ProPublica (Berg and Ernsthausen, 2024) revealed the difficulties many individuals find in reaching a mental health provider in a network with their insurance. Interviews with psychotherapists who had left insurance networks found that many struggled to accept insurance due to issues, such as denied payments, low reimbursement rates, and restrictions of services covered making remaining in a network with insurance unviable.

Yet, with private-pay psychotherapy often costing between $100 and $200 a session, many who need psychotherapy are left with the price of finding therapists within a small pool of those accepting their insurance.

It can be hoped that this policy change can serve as a bridge between providers and clients through intervention at a funding level.

Closing

In the end, mental health is physical health. With recognition of the gaps within the mental health system and access to care, as well as changes to policies affecting funders, we can hope that these necessary services will be available to all.