Today most Americans have insurance coverage for mental illness and addiction treatment, but might not even realize it. The Affordable Care Act (ACA) now requires insurance companies, including Medicaid, to cover mental health treatment as an essential health benefit with parity to medical illnesses. Those needing treatment for mental health and substance use disorders can finally receive it, thanks to recent legislation. The first, entitled the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed in 2008. The next included the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, which were signed together as the ACA originally in 2010. These laws have undergone various revisions and complex legislative processes since then and have been upheld.
The MHPAEA essentially requires insurance companies to pay for mental illness and addiction treatment as they do for physical disease. The MHPAEA and ACA combined to increase access to behavioral health care for a vulnerable population. As of July 1, 2014, about 87 percent of Americans are now eligible for free or affordable rehabilitation for mental and behavioral health disorders in addition to substance use, including smoking.
A full year has passed since these laws went into effect. Although the number of people needing mental health and substance use services has been steadily increasing, it is still too soon to determine whether those who want services receive them yet. Several difficulties contributing to the gap in services have already been identified. Some such difficulties include the following:
Those with greatest needs are least aware of coverage.
Insurance companies can make payments and reimbursements challenging, despite laws.
Some Americans and new immigrants remain uninsured to date.
More recent data are needed to compare the percentage of those who require and want treatment to determine whether these new regulations have improved access to care or whether greater public awareness is needed. The efficacy of preventive services and public awareness programs also needs to be assessed.
Mental health services and addiction treatment needed more than ever
Mental illness and addiction occur all over the world, though America has one of the most severe epidemics. Some reasons for this may be related to a vast number of factors affecting daily life in America, including:
More drugs being imported into the United States
Increasing an already-crisis incidence of mental illness and substance abuse problems
More prescription drug abuse
The societal acceptance of alcohol and other drugs
Strict American secularism and bigotry against monotheistic organizations
High actual unemployment rates and loss of coverage
Current severe economic and social conditions
No access to care due to a lack of insurance or other reasons
Poor individual insight related to illness
Lack of social support due to isolation and devaluation of the family
Not enough qualified counselors
Too few quality treatment centers
Despite these significant and often quite severe conditions, approximately 10 percent of adults in this country consider themselves in recovery from alcohol or drug addiction, according to a recent study. With 16.4 million newly insured out of 319 million Americans, more people will likely seek help. Current alcohol and drug use statistics are staggering, as are the rising rates of depression, anxiety and other mental illnesses. Suicide rates are higher than ever, with suicide now being the leading cause of death in Americans under 50 years of age. Yet as alarming as these statistics may be, the growing problem of mental illness and substance abuse has resulted in some positive trends.
A few positive trends that have become evident include a greater focus on prevention, less stigma and more research in the field. First, a greater focus on prevention may help lower risk. Recent survey data on adolescent drug and alcohol use suggested a recent decrease in illicit drug use. Next, as behavioral health problems become more common, the stigma surrounding treatment decreases, which may facilitate open and honest communication about substance use. Finally, more research in the field has increased understanding of the causes and effects of behavioral problems. This research has led to the development of novel treatment modalities that have been applied to the clinical setting, such as cognitive-behavioral therapy, neurofeedback and new medications.
Recent legislation now makes residential, outpatient or individual treatment available to most Americans with mental illness, substance use disorders and behavioral health problems. A renewed focus on prevention and education has resulted from these laws, such as teen drug awareness and employee wellness programs. The growing problem of mental illness, suicide and substance use disorders continues to skyrocket, but effective treatment is available to those in all socioeconomic brackets. Though barriers to care still remain, more focus on prevention, less stigma and new treatments emerge as positive changes resulting from this crisis.