Mental Health
Insurance Parity: A
View from the States
David L. Shern, Ph.D.
President/CEO Mental Health America
Academy Health Policy Conference
February 5, 2008
Washington, D.C.
Overview of the Presentation




Importance of Insurance Coverage for Mental
Health and Substance Use Conditions
Enactment of State Parity Laws Relative to the
1996 Federal Act
Characteristics of State Laws
Relationships to
 Utilization
 Outcomes
U.S. Has Highest Rates of Mental
Illness
U.S. has the highest prevalence rates
(26%) in the world in a comparison of 14
developing and developed countries.
(JAMA, 2004)

Mental Illness in Teens

Mental Illness in Children and Adolescents
Very Common
Disorders – 13.0% (Median age of onset 11)
 Mood Disorders – 6.2% (Median age of onset 30)
 Disruptive Disorder – 10.3% (Median age of onset 11)
 Substance Use – 2.0% (Median age of onset 20)
 Any Disorder – 20.9% (Median age of onset 14)
 Anxiety

Substantial Delays in Receiving Treatment
Disorders – 6 to 8 year latency
 Anxiety Disorder – 9 – 23 year latency
 Mood
(PHS, 1999; Kessler et al, 2005, Wang et al 2005)
The Impact of Behavioral Disorders Illustrated:
Suicide is the Leading Cause of Violent Deaths Worldwide
(World Health Organization, 2002)
Homicide
War
Suicide
5
In the United States
A Person takes His/Her Life
Approximately Every 16
Minutes
6
The Impact of Behavioral Disorders Illustrated:
The Disability Impact of Mental Illness
Illness Related Disability--United States, Canada, and Western Europe,
2000 (World Health Organization, 2001)
Mental Illnesses
Alcohol/Drug Use Disorders
Alzheimer’s Disease /Dementias
Musculoskeletal Diseases
Respiratory Diseases
Cardiovascular Diseases
Sense Organ Diseases
Injuries (Disabling)
Digestive Diseases
Communicable Diseases
Cancer (Malignant neoplasms)
Diabetes
Migraine
All Other Causes of Disability
0%
4%
8%
12%
16%
20%
24%
7
Prevalence of Depression in
Medical Illness
Percent With Depression
Medical Condition
Chronic Pain
52%
MI
40%
Stroke
40%
Asthma
Diabetes
45%
27%
Pincus HA. J Clin Psychiatry. 2001;62 Suppl 6:5-9; Schatzberg AF. J Clin Psychiatry. 2004;65
Suppl 12;3-4.
Impact of Depression:
Impact of Depression on Medical Cost
Comorbitities
Annual Medical
Costs per Patient
Without
Depression ($)
Annual Medical
Costs per Patient
With
Depression ($)
Heart failure
2.56
6.74
Allergic rhinitis
3.27
8.46
Asthma
3.73
10.56
Migraine
3.82
15.47
Back pain
11.61
33.25
Diabetes
13.06
27.28
Hypertension
13.38
27.16
Heart Disease
62.40
110.94
Condition
Actual annual medical costs per patient based on claims data for 229,776 patients, 1995-1998.
SOURCE: OCI 2001
State Parity Laws

38 States/DC Have Enacted Some Form
of Parity Law

5 Full or Best Parity
 7 Good Parity
 26 Limited Parity Laws
 13 Mandate Coverage of MH Services
 2 No Mandates or Parity
State Parity Laws by Year
10
8
6
State Laws
4
2
Year
7
5
3
1
99
97
95
93
0
91
Number of State Laws
12
Variations in Parity Laws

Best Parity Laws (5)
 Applies
to All Mental Health and Substance Use
Condition
 No exemptions for Small Employers or Cost
Increases
 Same Benefits as General Health Conditions
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Co-pays
Limits
Good Parity Laws (7)
 Often Exclude Substance Use
 Include Some Exemptions
Conditions
Variations in Parity Laws (cont)

Limited Parity Laws (26 States)
 Apply
to Select Groups
Often Persons with Serious Mental Health
Diagnoses (Schizophrenia, Bi-Polar Illness, etc.)
 Includes Exemptions
 Often Excludes Substance Use Conditions

No Parity but Mandates MH Services (13)
 No Parity or Mandates (2)
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Variable Estimates of Effect on
Service Utilization in States

Earlier Analyses by Sturm and Colleagues
(2000, 2004, 2004)Showed Limited to No Effect
on Utilization
 Importance of Covering the
 Effects of Managed Care

ERISA Population
More Recent Analyses by Harris et al. (2006)
 Increase
Utilization of Mental Health Services
 Particularly for Individuals with Mild to Moderate
Disorders
 Perhaps Indicative of Greater Penetration of Parity
Laws in more Recent Years
Mental Health America Ranking
Study – Depression and Suicide

Integrated Data from Several National
Data Sets to Examine Relationships
between System Characteristics,
Depression and Suicide Rates
 NSDUH,
BRFSS, CDC Suicide Rates
 MHA Parity Ratings for States
MHA State Ranking Study (cont.)
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Found Significant Difference between States
Parity Rating and Mental Health Service Rates.
 Best or Good
 Limited or No
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Parity Law = 15.8%
Parity Law = 13.4%
Significant Negative Correlation between Mental
Health Service Rate and Suicide Rate
Significant Positive Correlation between Rates of
Depression and Service Use
Several Other Indicators or System Capacity
Related to Decreased Rates of Suicide and
Depression
Conclusions
MHSU Conditions Prevalent, Disabling and
Expensive
 State Parity Laws appear to have Increased
Rates of Mental Health Service Use
 Utilization of Services may be Linked to
Positive Health and Behavioral Health
Status in the Population.
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