By now, mental illness was supposed to be taken as seriously as physical disease. California and several other states even created laws to that effect.
So-called parity laws require that insurance coverage for mental illness equals that for other diseases. Under California's law, passed four years ago, health plans can't require patients to pay higher co-payments for treatment, and they can't impose lower lifetime and annual caps on benefits. If the lifetime maximum benefit under a policy is, say, $2 million for physical illness, then it must be $2 million for mental illness as well. The number of days allowed for hospitalization also must be the same.
Such efforts to elevate the status of mental illness have made it to the federal level -- proposed federal legislation would require insurers in all states to provide equal benefits.
Though laudable, the laws have not remedied longtime inequities, mental health advocates say. "The parity law was intended to create an atmosphere where people would feel comfortable asking for service and erase the stigma associated with the disease," says Randall Hagar, director of governmental affairs for the California Psychiatric Assn. "It was supposed to provide access to treatment by providing higher benefits."
Californians who suffer from mental illness now receive equal reimbursement, but they may not be receiving high-quality care. In its most recent annual report card, the National Committee for Quality Assurance, a nonprofit group that accredits and evaluates health plans, said that although some plans improved care for patients with certain physical conditions in 2002, care did not improve for those with mental illness.
The committee noted that over the last four years there has been little improvement in treatment rates for depression. For example, generally accepted standards of medical practice call for people who receive a diagnosis of depression and a prescription to have at least three visits with their physician in the next 12 weeks. But only 19% saw their doctors that many times in 2002. Only 11% of patients on Medicare had the optimum number of visits.
When it came to proper follow-up treatment after a hospital stay for mental illness, only about half received care within seven days of leaving the hospital.
By contrast, more than 90% of heart attack patients received life-saving beta blocker treatment in 2002 and 80% of women were screened for cervical cancer.
