One Step Closer to Mental Health Parity

Abstract

The estimates for the incidence of some type of mental illness in the United States are remarkably high: approximately one in four. In theory, antidiscrimination protection under the Americans with Disabilities Act and health insurance should help that 25% of the population. However, the ADA has not been effective in mitigating the effects of discrimination upon the mentally ill, and health insurance coverage has been both discriminatory and deficient. Insurance plans and policies offer less coverage and more limits on the mentally ill than on any other patients, and companies almost never accommodate mental illness or tolerate the symptoms of those diseases. Congress tried to address these shortcomings through the proposed Mental Health Parity Act of 2007, an amendment to the Employee Retirement Income Security Act, the federal law that regulates most employee benefits, to little avail. In the meantime, the Supreme Court made it more difficult for those with mental illness to fit within the ADA's protections. However, important changes to these laws could significantly improve the lives of the mentally ill. On September 25, 2008, significant amendments to the Americans with Disabilities Act were signed into law. Less than one month later, mental health parity in employer-provided health insurance became a federal mandate when the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008 was quietly enacted as part of the first economic bailout. At a time when the Obama presidency is framing the social issues for the next half-decade, and when a woman accepted the Republican vice-presidential nomination moments before cradling her special needs infant in her arms, mental health is ever-present in the news. That is atypical. In over a dozen years, no significant legislation nor federal agency has focused on the problems associated with mental health since David Satcher, former President Bill Clinton's Surgeon General, reported glaring disparities that violated not only civil rights, but best medical and management practices. Until now, mental illness demonstrated an almost irreconcilable conflict between economy and shame, made even worse by stereotypical thinking that stigmatizes the mentally ill or impaired, and wastes important human capital.