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Equal Coverage For Mental Health?
Many States Require Parity, and Congress May Order It Nationwide

By Alicia Ault
Special to The Washington Post
Tuesday, November 6, 2007

Q Why are my mental health benefits less generous than those that my insurance policy provides for other conditions?

A When mental health coverage was first added to benefits packages a few decades ago, there was still a persistent belief that a condition like depression was not as real as heart disease or cancer. There also were few medications or other therapies that offered significant improvement. Many employers did not offer rich coverage because they assumed the government would eventually pay for treatment of serious mental illnesses such as schizophrenia or bipolar disease.

Beginning in the early 1990s, as therapies improved and awareness grew that mental conditions are genuine illnesses, patient and professional groups and some in Congress began to press for federal laws to require equal coverage of mental and physical health, meaning for example equivalent co-pays .

The initial effort was led by Sen. Pete Domenici (R-N.M.), who has continued to champion the cause. Currently, 42 states, including Maryland, require equal coverage. The federal employees' health benefit program also requires equal coverage. But 82 million Americans work for employers who self-insure, which means they are exempt from state parity laws, said Andrew Sperling, legislative affairs director for the National Alliance on Mental Illness. An additional 31 million are in other plans that don't have to offer equal coverage.

In September, the Senate unanimously passed the Mental Health Parity Act, which would require equal coverage. The proposal has won the backing of three committees in the House. The chances for passage this year are good, experts say. "It's a perfect storm in a good way," said Carolyn Robinowitz, president of the American Psychiatric Association.

If I use my mental health coverage to talk to a therapist or get medications from a psychiatrist, could my employer use this information to treat me differently at work or maybe even fire me?

Despite growing awareness that mental illnesses are scientifically documented and treatable diseases, fear of discrimination still makes some people wary of admitting they have depression, anxiety or other conditions. And that makes many apprehensive about seeking treatment -- much as people with cancer were fearful 20 or 30 years ago, Robinowitz said. Ron Honberg, policy and legal affairs director for NAMI, agrees that fear of discrimination is a barrier to care. "Whether it's perceived or real, it's something people worry about," he said.

Some laws aim to offer protection: privacy laws to prevent disclosure of personal medical information to unauthorized users; and the Americans with Disabilities Act, which bars discrimination for a perceived disability, which could include a mental illness.

But the world is not perfect, and some people may be wrongly exposed or fired, as can be the case with pregnancy or any medical condition.

I'm worried about the cost of treating my mental disorder. Do counselors or psychiatrists ever adjust their fees?

You may be able to get treatment for a reduced fee. Many larger companies offer an Employee Assistance Program, which often provides limited phone counseling for free.

Public mental health clinics in most localities also offer some care free or at a reduced rate, depending on income. Your state's mental health department help line can steer you to those clinics.

The American Psychological Association offers a consumer-oriented Web site ( http://www.apahelpcenter.org) as well as a referral service (800-964-2000); once connected with a local counselor, you can ask whether they operate on a sliding scale.

The American Psychiatric Association recommends asking practitioners if they will reduce fees, and offers other resources at http://www.healthyminds.org.

Georgetown University, George Washington University and Howard University offer mental health services, often at a reduced rate for lower-income individuals.

NAMI's Web site ( http://www.nami.org) also offers resources for patients. Robinowitz also suggests seeking help from support groups: Advocacy organizations for almost every disorder can be found in the phone book or on the Internet.

Alica Ault is a Washington area freelance writer. Comments:health@washpost.com.

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