Access, Expansions, Parity galore!

Promises for Mental Health Reform

MentalHealth-HeadGraphic-250px_1  Mental health care services have always been very limited and continue to dwindle in the USA.  Even with the creation of the Mental Health Parity Act in 2008 there have been many cuts to mental health services.  With 1 out of 4 Americans to have an experience with mental illness, there is a great need to increase mental health services, not cut them from the state budget.  The stigma that is associated with mental illness and the cost of such care has led to severe cuts in emergency services, inpatient beds, residential programs, therapy and counseling services, and substance abuse programs leading many mentally ill citizens to homelessness, nursing homes, and jails which are not equipped to care for their mental illness.   In order to improve the mental health of our country, health reform efforts have to ensure proper care not only for physical illness but also mental.[1] Providing adequate community services might help to reduce and prevent ER visits and hospitalizations that are costly.

As of now there are 11 million people living with mental illness that are uninsured in the United States.[2]  The Affordable Care Act (ACA) has promised to expand the parity act to ensure that mental health and substance abuse services are delivered to those who need them.  The expansion and new reforms look very promising:

  • For those not insured, coverage through marketplaces will be more easily accessible
  • Insurers cannot deny coverage due to a pre existing condition such as depression or bipolar disorder
  • People will get overall better care through essential benefits packages to focus on the continuum of care, not just specific treatments
  • There can be no lifetime limit on mental health care[3]

While these are all great improvements, many of these have not gone into effect yet.  It is hard to tell how successful they will be.  A major concern for those with mental illness is that many will not be covered by these expansions everywhere due to many states’ decision not to expand Medicaid.  Without the Medicaid expansion treatment and care will be very hard to access for those most in need of mental health services.[4]  Only time will tell what the results will be to understand the scope of mental health coverage in the US.  The need for better mental health care is great, so lets cross our fingers!

I end this post with some thought questions:

Will a change in political leaders or a balance of power at the state or federal level influence decisions to expand Medicaid? Will there be new incentives for these states?  How will the coverage play out for those with mental illness in states not expanding?  What will other countries learn from our reform as mental illness becomes a growing burden of disease?


[1] Landsberg, G. & Rock, M. (2010) The context of social work practice: Social policy and social work. Learning Solutions: New York.

[2] NAMI. (2013) Health reform and mental health. Issue Brief  Retrieved from:

[4] Grohol, G. (2013) An update on how the US Affordable Care Act impacts mental health care.  Retrieved from:


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