Mental health parity law implementation evolves
Filed under: Government, Health care reform, Hot Health Headline
Writing for Kaiser Health News and The Washington Post, Sandra Boodman considers the effect that the American mental health parity law has had since it went into effect on Jan. 1.
The law applies to about 140 million Americans, Boodman writes, most of whom are insured by employers with more than 50 employees. For qualifying groups, “Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment.” It doesn’t apply to individual policies and doesn’t require employers to offer mental health coverage of any kind.
There are still questions about the implementation of the law, many of which are addressed in the Obama administration’s implementation plan (PDF), which should take effect on July 1.
Officials of key business and insurance industry groups said they were displeased that the regulations were “more expansive” than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.
Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.
Fortunately, it looks like that sort of cost increase will be rare, based on research that shows similar rules improved access without increasing cost.
For some background on the mental health parity law, check out MIWatch.org.
Comments invited on latest draft of DSM
A new version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has come out every decade or so (it varies widely) since 1952. 
It hasn’t substantially changed since 1994, but the next revision is slated to come out in 2013. It’s a pretty big event, as the book’s diagnostic criteria are used around the world to determine who is diagnosed with mental disorders.
With the release of the new version, lines may shift and folks who were diagnosed with mental disorders may find themselves “undiagnosed.” Others will have labels changed and gain labels they didn’t have before.
The latest draft proposal of the May 2013 revisions, upon which public comment will be accepted until April 20, 2010, was posted on Feb. 9. APA workgroups will review the comments and begin trials soon after. Benedict Carey rounded up and evaluated some of the biggest proposed changes for The New York Times. In addition to bipolar disorders in children and autism spectrum disorders, Carey discusses the sheer significance of the changes.
“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.
“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”
More vets come home as result of psychiatric issues
On Shots, NPR’s Health Blog, Nadja Popovich reports on a recent Johns Hopkins study that found, more troops were evacuated from Iraq and Afghanistan in 2007 for mental health problems than for combat injuries.
The increase comes despite the military’s increased focus on combating mental health problems among American soldiers. The largest number of evacuated soldiers are still those diagnosed with “noncombat-related injuries, such as muscle and joint problems that come from carrying equipment,” but psychiatric evacuations are a growing and complex problem.
American paratroopers in Afghanistan. Photo by U.S. Army Spc. William E. Henry via Flickr… those suffering from mental health issues had a remarkably low rate of returning to full duty. “Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries,” (study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve) wrote. “But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions.”
“Patients with PTSD — as a rule — have multiple other complaints,” he continued. “Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment.”
Related AHCJ articles
Interviewing ‘profoundly affected’ soldiers
Tips for interviewing service members returning from Iraq, the Middle East or Afghanistan
Trib looks into dangerous nursing home residents
The Chicago Tribune’s Gary Marx and David Jackson examined the effectiveness of Illinois regulations implemented in 2006 to protect nursing home residents from potentially dangerous peers. They’ve pulled together some alarming anecdotes and data that show the law is not as effective as hoped.
For example, the reporters focus on the man with a criminal record who attacked by another resident with an ice pick. Just a year after the attack, he ended up in the same facility as his victim again. This time, he slashed him with a box cutter. Obviously, there was a hole somewhere in the new system. Marx and Jackson lay out the facts:
With growing numbers of mentally ill felons entering Illinois nursing homes, the state in 2006 became the first to require criminal background checks as part of an overall risk assessment of new residents. The screenings by state contractors are used to identify high-risk individuals who should live in private rooms and be closely monitored.
But a review of confidential reports in 45 recent cases shows that in many instances the assessments were incomplete, leaving out some criminal convictions and other crucial details.
The project includes a searchable database of safety reports on nursing homes in Illinois, including information not searchable on government sites. Readers can use the database to find out the number of residents at a facility who are convicted felons and sex offenders, crimes reported at Chicago nursing homes and fines levied because of deficiencies in care. Head over to the investigation’s homepage to follow the story and its results.
Tompkins: Juvenile jails taking on mentally ill youth
Al Tompkins, the reliable story-spotter at the Poynter Institute, jumped at the potential to localize a New York Times story on how cash-strapped mental health systems are allowing young offenders with psychiatric disorders to be handled by the juvenile justice system instead of by mental health specialists.
According to The New York Times, which refers to the current situation as a “crisis,” two-thirds of the nation’s approximately 92,000 juvenile inmates suffer from at least one mental illness while at least 32 states are slashing the budgets of their mental health programs.
DoD campaigns against stigma of depression, PTSD
The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury’s new Real Warriors campaign is designed to aid soldiers with what they seem to see as the three r’s of military mental health: resilience, recovery and re-integration.
The RealWarriors.net site not only directs soldiers to additional resources, but also shares anecdotes from their peers and provides them with guidelines for good mental health, both in combat and out of it.
The effort, launched in May, even has a Twitter account.
(Hat tip to Arline Kaplan of the Psychiatric Times)
Related:
Bay Area panel on veterans’ health highlights untold stories
Disabled student abuse goes unpunished in Nev.
Darcy Spears, a reporter at KTNV-Las Vegas, has discovered a number of disturbing stories of teachers abusing special needs students in area schools; in some cases the districts worked to keep the details of the abuse from parents and punished offending teachers lightly, if at all. According to KTNV, there are dozens such violations reported every year.
In Part 1, Spears follows a then-5-year-old autistic boy who, when he wouldn’t eat his lunch, was violently force-fed until he vomited. Police were called, but the boy’s family still weren’t able to get an incident report until they involved legal counsel.
Despite specific Nevada laws prohibiting such actions and requiring disclosure, the incident only came to light because aides to the offending teacher reported it to school administration and local police.
Nevada law says physical restraint may not be used on a pupil with a disability unless there’s an immediate threat of physical injury to students or staff, or to protect against severe property damage.
All instances must be documented and reported to the school district and the parents.
In Part 2, Spears looks at the story of a 7-year-old autistic boy whose mother says he was abused and that the school has swept the case under the rug and a whistle-blowing special education assistant who details the abuse he’s seen take place in Nevada classrooms.
Related
Bernstein, Silberner awarded Carter Fellowships
AHCJ members Elizabeth Bernstein and Joanne Silberner have been awarded Rosalynn Carter Fellowships for Mental Health Journalism for 2009-10.
Bernstein, of The Wall Street Journal, will examine the impact of the economic recession on people with mental illnesses while Silberner, of National Public Radio, will produce radio stories about the treatment of mental illnesses in developing countries.
In its press release, the Carter Center says it received a record number of applicants for the fellowships this year. The fellowships allow journalists to pursuing topic - from their own newsroom - that may not otherwise be brought to the public’s attention. Fellows in the United States receive a stipend of $10,000 to study and report on a particular issue within the field for one year and receives training on covering mental health issues from leading experts.
Projects that past fellows have done have been recognized by Mental Health America, the American Psychological Association, Amnesty International and AHCJ, as well as Emmy and Pulitzer Prize nominations.
A painful picture of rare childhood mental illness
The Los Angeles Times’ Shari Roan tells the story of a 6-year-old girl suffering from a rare – perhaps even unique – case of early childhood schizophrenia. For months, even the most powerful medications her young body can handle don’t seem to phase her imaginary animal friends and almost-constant hallucinations. The mental illness is a serious threat to her health and that of those around her. In January she had to be moved from home to UCLA’s pysch ward. Roan uses the story, told with intense, wrenching detail and ending with a note of hope for the future, to illuminate the plight of America’s tiny population of mentally ill children.
About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.
Doctors and other mental health experts don’t fully understand the disease, which has no cure. Jani’s extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.
“Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia,” says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children’s study, the largest such study in the world on the illness.
Advocacy group releases mental health media guide
The second edition of a media guide for reporting on suicide and mental illness, prepared by Wisconsin United for Mental Health, is now available. The guide, “Open Minds Open Doors: A guide for Media,” provides statistics, facts and background data as well as suggested terminology and guidelines for avoiding the stigma of suicide and mental illness. The guide recently won a Mental Health America 2009 Media Award in the advocacy category.
According to Wisconsin United for Mental Health’s Web site, its mission is to “educate and increase awareness about mental illnesses, to eliminate stigma and discrimination, and promote recovery.”
-
Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
