With the recent passage of the federal bailout of the financial industry, a groundbreaking piece of legislation was passed that will significantly affect mental healthcare in the U.S. This bill stipulates that mental health conditions must receive the same insurance coverage as physical health conditions. Thus, treatment for schizophrenia or OCD will not be covered with different annual limits, co-payments, and deductibles than those for, say, arthritis.
This legislation became necessary because health insurance companies in the past 15 years have found it profitable to limit coverage for mental health services, and because existing laws did not prohibit such a practice. Individual states had passed legislation in recent years to prohibit this practice on a statewide basis. Timothy’s law in New York is one example, but other states have passed similar laws, including Massachusetts, Oklahoma, and California.
The states’ parity laws have varied, to this point, on which mental health disorders would be covered. The federal law does not specify which disorders must have parity. Some states’ laws state that only “biologically based” conditions would be covered. What these are, however, varies from state to state. Most typically, OCD, schizophrenia, major depressive disorder, and schizoaffective disorder are considered to be “biologically based.” However, the notion that some mental disturbances (and not others) are rooted in physiological problems is a dubious one. The brain contains billions of neurons connected through trillions of synapses, each of which has relevance for how we understand, perceive, move, think, or behave. Learning occurs by reconnecting neurons to one another in different patterns. So, by reading this paragraph, e.g., your brain cells are physically affected. Similarly, anytime that organisms learn to fear something, changes in neurophysiology occur. This means that if you develop a fear of elevators, water, or flying, brain changes occur. Someone who suffers a traumatic event like an assault or an accident and then avoids reminders of the event can also say their neurons were “rewired.” The notion that some disorders have “neuronal correlates” in the brain and some do not is oversimplified. However, out of this oversimplification, millions of Americans have the beginnings of fair access to mental health coverage.
David Shern, the president and CEO of Mental Health America, was quoted in the New York Times as saying “this is a historic day and a great civil rights victory for millions of Americans who have been unable to access mental health treatment… With approval of this bill we will tear down the walls of stigma and discrimination and open the doors to the power and promise of treatment and recovery.” History may prove this to be more hyperbole than prophetic, but the years-long efforts of legislators and mental health advocates should be recognized in getting this bill passed.