From the Practice Directorate

Full Mental Health Parity legislation requires that group health plans of 50 or more employees equally cover mental and physical health benefits.

Full Mental Health Parity is Now Law

When President Bush signed full mental health parity into law on October 3, the U.S. took a great step forward in the decade-plus effort to end health insurance discrimination against those seeking treatment for mental health and substance use disorders. This historic legislation requires that group health plans of 50 or more employees equally cover mental and physical health benefits.

Equity in coverage will apply to all financial requirements, including lifetime and annual dollar limits, deductibles, copayments, coinsurance and out-of-pocket expense, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage and other similar limits. The new parity law takes effect on January 1, 2010.

"With the passage of this bill, insurance companies can no longer arbitrarily limit the number of hospital days or outpatient treatment sessions, or assign higher copayments or deductibles for those in need of psychological services," said APA Executive Director for Professional Practice Katherine Nordal, PhD.

The 2008 law closes several loopholes in the 1996 Mental Health Parity Act, which remains in effect through 2009. It preserves existing state parity and consumer protection laws while providing mental health services to 82 million Americans not protected by state laws. The new law also ensures mental health parity for both in-network and out-of-network services.

A summary of the new parity law appears in this issue. Also see questions and answers for psychologists about the law and how it will affect professional psychology.

Beginning more than a decade ago, the APA worked with Congress to achieve a full mental health parity law. Since its creation in 2001, the APA Practice Organization (APAPO) has kept up the push for parity in myriad ways. Learn how the APAPO has been in the forefront of advocacy to gain a full parity law.

According to the National Institute of Mental Health, more than 57 million Americans suffer from a mental health disorder. A 2008 nationwide survey by Harris Interactive commissioned by the APA found 25 percent of Americans do not have adequate access to mental health services and 44 percent either do not have mental health coverage or are not sure if they do.

Additionally, a 2006 survey from the Substance Abuse and Mental Health Services Administration reports that 49 percent of U.S. adults with both serious psychological distress and a substance use disorder go without treatment.

"Research shows that physical health is directly connected to emotional health, and millions of Americans know that suffering from a mental health disorder can be as frightening and debilitating as any major physical health disorder," said Dr. Nordal. "It's our hope that passage of this bill will force our health care system to finally start treating the whole person, both mind and body." Read more from Dr. Nordal about the positive impact the new law is likely to have.



Americans Stressed Over Economy, More Report Symptoms

With the growing financial crisis and the rising costs of gas, food, and healthcare, Americans are clearly experiencing heightened stress. The American Psychological Association's 2008 national Stress in America survey reveals what Americans are stressed about, what they are doing to manage that stress, and how stress is affecting their health.

The Stress in America annual survey is part of APA's public education campaign, "Mind/Body Health: For a Healthy Mind and Body, Talk to a Psychologist," which highlights psychology's unique role at the intersection of mental and physical health.

Among the 2008 findings:

Women are bearing the brunt of financial stress.

In September, more women than men report being more stressed about money (83 percent vs. 78 percent), the economy (84 percent vs. 75 percent), job stability (57 percent vs. 55 percent) and housing costs (66 percent vs. 58 percent).

The financial downturn is taking a toll on older women, but all are affected.

Women of the Boomer generation (aged 44 to 62) and Matures (aged 63+) are most likely to report the economy as a significant stressor, while women in general say they are more worried about money than their personal health.

Female Boomers report increases in stress associated with their job stability and health problems affecting their families. Mature women are reporting dramatic increases in stress associated with health problems affecting their families (up 17 points to 87 percent between April and September), the economy (up 18 points to 92 percent) and money (up 15 points to 77 percent).

Generation Xers (ages 30 to 43) and Millennials (ages 18 to 29) are not immune from financial worries. Generation Xers are the women most concerned about money (89 percent report money as a source of stress) and Millennials are most concerned about housing costs (75 percent report housing costs as a source of stress).

More people report physical symptoms of stress compared to 2007 survey data.

Over the summer, more people report fatigue (53 percent compared to 51 percent in 2007), feelings of irritability or anger (60 percent compared to 50 percent in 2007) and lying awake at night (52 percent compared to 48 percent in 2007) as a result of stress, in addition to other symptoms including lack of interest or motivation, feeling depressed or sad, headaches and muscular tension.

Women were more likely than men to report physical symptoms of stress like fatigue (57 percent compared to 49 percent), irritability (65 percent compared to 55 percent), headaches (56 percent compared to 36 percent) and feeling depressed or sad (56 percent compared to 39 percent).

Many adopt poor habits to cope with stress.

Almost half of Americans (48 percent) report overeating or eating unhealthy foods to manage stress. Women are more likely than men to report unhealthy behaviors to manage stress like eating poorly (56 versus 40 percent), shopping (25 versus 11 percent), or napping (43 versus 32 percent). Almost one-fifth of Americans report drinking alcohol to manage their stress (18 percent), and 16 percent report smoking.

Methodology

The 2008 Stress in America research was conducted online within the United States by Harris Interactive on behalf of the American Psychological Association between June 23, 2008 and August 13, 2008 among 1791 adults aged 18-plus who reside in the United States.

Additional data was collected in September; it was compared to data from April. The April data was collected online within the United States between April 7 and April 15, 2008, among 2,529 U.S. residents aged 18 or older. The September data was collected online within the United States between September 19 and September 23, 2008, among 2,507 U.S. residents 18 or older.

Data for the April and September polls were collected using an omnibus survey; the causes of stress question included a "not applicable" response. Data presented here were calculated excluding those who responded "not applicable."

No estimates of theoretical sampling error can be calculated; a full methodology is available.

To read the 2008 and 2007 Stress in America Findings, click here.



Mental Health Grant Offers Alternative to Incarceration

On July 25, Several APA members and staff answered questions and provided material on resilience, mind/body health, and psychology in general. Approximately 200 people attended.

The federal government has reauthorized an important grant program strongly supported by the American Psychological Association Practice Organization (APAPO) to improve mental health services to non-violent offenders.

On October 14, President Bush reauthorized The Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) from fiscal year 2009 through 2013 at $50 million per year. The Act, first passed in 2004, authorizes federal grant money to help states and local communities fund collaborative efforts between the criminal justice, mental health and juvenile justice systems aimed at reducing the criminalization of people with mental disorders.

These efforts include:

  • mental health courts, which link non-violent mentally ill offenders with support services, treatment, employment and housing

  • jail diversion, alternative prosecution, and sentencing programs

  • treatment for incarcerated individuals with mental disorders

  • community reentry services

  • cross-training of criminal justice, juvenile justice and mental health personnel.

The Act also authorizes new grants to train law enforcement personnel to respond to incidents involving mentally ill individuals and requires the U.S. Justice Department to report on the rate of serious mental illness among those in custody or on parole.

According to a 2006 report by the Federal Bureau of Justice, an estimated 1.25 million inmates suffer from mental disorders. In 2003, the president's New Freedom Commission on Mental Health found that mentally ill offenders frequently do not receive appropriate mental health services in jail or upon discharge and suffer a high recidivism rate.

Key Advocacy from APAPO and Psychologists
MIOTCRA has been one of the APAPO's key legislative priorities for several years. The APAPO has partnered with the Campaign for Mental Health Reform, a coalition of 17 mental health organizations including the American Psychological Association (APA), as well as the Council of State Governments to advocate for the legislation's passage and funding.

Over the years, practitioners have provided critical grassroots support, with APA Practice Organization Federal Advocacy Coordinators mobilizing hundreds of psychologists in select districts to weigh in with key Senate and House committee members during important stages of the legislative and appropriations process.

During the 2008 APAPO State Leadership Conference in Washington in March, hundreds of psychologists met with their representatives and staff on Capitol Hill to ask for funding and support for the program.

Getting Involved in Your Home State
MIOTCRA funds planning and implementation grants, which require collaboration between mental health service providers and local correctional departments. All applications will need to demonstrate that collaboration to be considered for a grant.

The U.S. Bureau of Justice Assistance Web site at http://www.ojp.usdoj.gov/BJA provides information on the program and resources for grantees. Those psychologists interested in providing services to planned or established mental health courts should contact their state department of justice or corrections for more information.

For additional information on the MIOTCRA, members can also contact Cordell Francis, MSW, Director of Congressional Affairs in the Governmental Relations Department of the APAPO via Email or (+1/202) 336-5871.