Enforcing mental health parity

Enforcing Mental Health Parity Comment by Nicole Diggs: This group has some work to do. What is the problem? What is the criteria for policies attempting to be the solution to mental health? I was extremely confused reading this paper because it seemed to jump from one idea to another without full explanation. I.e. It was never stated that mental health is associated with jail or crime rates. Never assume that your reader knows about Mental Health or Mental Health Parity. You have to explain in detail to help your reader understand the purpose of the paper. I need this group to rework this.

Aja M. Halcomb

Jason Morris

Kathryn De Rama

Nina Bourda

Timika Dollar Orr

California State University, East Bay

Problem Identification Comment by Nicole Diggs: Start this section by telling me what mental health is? What constitutes having a mental illness?

The mental health parity bill was meant to make things better regarding mental illness treatment. Before the bill was passed there were numerous problems that called for a change. Some of the problems that required solutions include the following: first, unlike the other physical ailments such as diabetes, mental illnesses were discriminated in terms of the how health care was managed. The medical care for people suffering from mental problems could not be compared to the treatment of other ailments, it was poor. One of the greatest challenges in mental health care provision was the resources. Many hospitals did not have enough psychiatric beds to accommodate the mental patients, therefore, the patients often times waited for more than three days to be admitted. My suggestion; as a result, the lack of bed space has remained problematic, now becoming a nationwide issue. Comment by Nicole Diggs: What are you trying to say here? Comment by Nicole Diggs: Why are suggestions being made when identifying the problem

Secondly, serious mental disorders that range from schizophrenia to depression require swift attention. The most alarming situation is the frequency of tragedies resulting from improper care regarding mentally ill people. Increased cases of deaths and gun suicides are evident, for instance, the 20 school children massacre in 2012 that happened in Newton was a great push for action to be taken; this called for a great awakening regarding mental illness. There are also many other cases of patients that were not admitted from killing their loved ones and committed to suicide. Therefore, another major problem is that mentally ill people are dangerous not only to the public but to themselves. Failure to help them poses a great danger to the society and possibilities of great loss of not only loved ones but also manpower, as the people injure and harm themselves due to their mental conditions (Mukherjee, 2016). Comment by Nicole Diggs: According to who? Comment by Nicole Diggs: Needs further explanation for clarity Comment by Nicole Diggs: Please clarify

Third, stigmatization is another major problem threatening people with mental illnesses since they are viewed as dangerous leaving them to feel isolated and discriminated(insert citation). Discriminating people does not help but serves to worsen the situation because they become more violent as they try to find justification and love. The best place for people is not prison where there is no system established to take care of them at all. There is a need to take serious actions regarding people of mental illness instead of letting mental ill people who are too dangerous to the society and are not medically treated lead to multiplication of crimes in the nation. It is important to focus on the issue of the mental health care and come up with a better system that provides good care to the victims instead of pushing them to prisons. It is also inhuman to have jails serve as the major care givers of people with mental illness when mental facilities can be established to provide treatment for mental health victims. Correctional facility work to instill discipline and mental health victims need effective treatment and care on the other hand (Mukherjee, 2016). Comment by Nicole Diggs: I’m extremely confused on how we got to this

Lastly, with the Mental Health Parity Act, it gives hope to the non-profit groups campaigning for people with mental illnesses. This act was meant to improve health care provision for the mental patients; this was to start with provisions of the missing resources in the hospitals such as the psychiatric beds and professionals to attend it. Additionally, another issue that the bill intended to address was affordability; insurance companies did not sponsor mentally illness patients as it sponsored other illnesses. There tends to be a lack of resources and accessibility for mental health patients as treatment is only reduced to psychiatric hospitals and prescribed medications. There were limitations even when the medical care was required which included but not limited to: the insurers would not pay for the bills, , the insurers getting a lot of profit from their customers and resulting to the lack of healthcare access for mental patients from low-income backgrounds. Enforcing the Mental Health Parity Act will rejuvenate new hope for Americans, advocates and non-profit groups who campaigned for better terms regarding the mental health care (Noonan & Boraske, 2015). Comment by Nicole Diggs: Needs clarification Comment by Nicole Diggs: Needs clarification

The Parity Violation

In spite of the enforcement of the Mental Health Parity Act, problems were still evident. Compliance is a problem for insurance companies. There are incidents where they are not willing to pay for required medical checkups by simply stating that the treatment is not medically necessary when it is. Another problem is that insurance companies do not clearly give the policies of operations to their clients on the areas of what treatments are medically necessary. Statistics show that those who are denied health treatment really needed it but are denied based on unrealistic reasons, “Plans may use subtle ways to make mental health and substance use treatment less available than treatment for other medical conditions.”(citation needed) A National Alliance on Mental Health Illness survey, released this past April, states that 29 percent of patients were denied mental health care based on “medical necessity,” compared to 14 percent of patients denied care for other conditions” (Meadows, 2015). The parity violation occurs due to the lack of the right precautions to enforce the mental health parity law in various states; “since 2010 the Department of Labor reported just 140 potential parity violations”, “Similarly, Kaiser Health (Meadows, 2015).

Mental Health Access Awareness

Lack of awareness is another problem why mental patients still do not have the right access to proper care; this is due to mentally ill patients not being aware of their health care rights. Therefore, the government has not made enough efforts to carry out campaigns on education of the educating citizen’s about their rights regards regarding parity. With enough knowledge on the health policies people won’t be denied their rights and they will be careful when choosing their health insurers. Additionally, most people do not know where to turn to when their mental health access rights have hit rock bottom. Again, the issue of mental care should be explained in length and in details with every important issue discussed.

Finding an Acceptable Solution

The law makers and the federal government haves made its efforts in coming up with a mental health parity that can help mental patients access quality care without discrimination and stigmatization. However, the issue of compliance has become a problem especially for companies. A good criterion to get a better solution should entail the following. First, the government should mandate every hospital to have a mental health care advocate who can help those who do not know where to turn to; this will also help in providing the necessary knowledge and enlighten enlightenment as well. Additionally, having such a person will help nail down those insurers who do not want to comply with the parity for their own selfish gains. Comment by Nicole Diggs: Edit Comment by Nicole Diggs: What do you mean?

Secondly, the government should review the mental health parity with insurance companies to ensure that patients are receiving the right kind of services. This will make it much easier to find better solutions on terms and conditions so that it will be easy to solve the issue of compliance such as funding. Third, the government should make sure there are enough resources in hospitals to take care of the mental ill; this should be for the good well- being of the nation so crime rates can be reduced since crime rates are associated with mental health patients. Having enough resources will not result to some patients being taken to jail for behavioral corrections instead they can be admitted to mental health care facilities where they can be treated and taken care of (Gnadinger, 2015). Comment by Nicole Diggs: What do you mean?

Lastly, the government should come up with policies that penalizes individuals that do not complying with the mental health parity or any major health care policies related. Even mental health providers who do not accept insurance should be asked to do so. With all that in consideration there will be a better promise to improve health provision for mental ill people within society.

Identification of Stakeholders

There are a number of stakeholders within these solutions that have direct impact on the improvements of mental health, with stakeholders being anyone that may have a positive or negative impact on the proposed solutions for improving mental health disparity. The first solution was to mandate mental health advocates in all hospitals. These advocates would serve as patient social workers to educate as well as empower the patients and their families on how and when to seek and obtain resources. Advocates promote and increase awareness, identify funding programs to increase resources, serve in the local communities to identify alternative care options, and represent patients on behalf of their own advocacy agency to ensure fair patient treatment and actions are being taken with urgency and efficiency. The identifying stakeholders are: the advocates/ social workers, patients, mental health providers, insurers, and family members/ care givers that have any responsibility with mental patients. The advocate is to oversee the patient’s resource pool and identify ways to obtain funding, while it is the providers job to identify the gaps in treatment and act responsibly in getting the patient set up with an advocate to address treatment needs. The advocate is an active liaison to speak on behalf of the patients, not to become as enemies with doctors and insurers but working as a partnership for the needs of patients. The advocate’s role is also similar to a case worker or case manager that evaluates and analyzes needs and identifies solutions on how to close the gaps in the need for services for the mentally ill.

Solution two proposed a required extensive review of mental health parity within insurance plans to ensure that insurers are openly offering the right kind of services for patients. Plans should be standard that “combine multiple needs of a medical, psychiatric, and social nature” treatment to improve behavior of the patients (Lorant, Grard, Nicaise, 2016). Plans should also identify external resources if there are limited services within the standard coverage. It is unnecessary to fail the health of the patients because of limitations of coverage due to location and/ or environmental factors where services are scarce; when extensions can be approved to extend services beyond geographical areas. The identified stakeholders in this solution are the insurance companies, providers, patients, and policy review committees that will determine the extent of the accessible services and funding to be deemed acceptable. If plans were less than acceptable per policy review, companies would have to re-evaluate the services offered until the standard is considered acceptable by policy review.

The third solution proposed is that government increases the number of resources to mental ill patients. As a result, this would decrease the incidents of crime that occurs by “mentally ill criminals” for both small and major violations. Many cases go unresolved when defendants plead not guilty by reason of insanity. This is not always justified because the insanity plea or incoherent state of the patients are mostly never documented until they are in the legal system looking for a defense. If the government were to provide additional services for “social rehabilitation and recovery of psychiatric service users” (Lorant, 2016) then records for treatment and services can be sustained that show history of the patient’s illness to justify insanity pleas in court cases. Government resources would need to expand to community wide facilities that accept almost all insurance plans, associate with all hospitals and providers, and determine a clear distinction between behavioral health illnesses so that patients are not all wrongly classified as a threat to society. The stakeholders in this solution are: mentally ill patients, mental health administration, mental health advocates, health care providers, insurers, and policy committees that hold insurers to their standard, which then should be available within government or community based facilities by operating up to standard per the policy review committee, and extended resources per insurers.

The final solution proposes penalties for non- compliance mental health parity or related policies. Compliance standards are put in place to ensure quality. Groups or persons such as advocate agencies, social workers, case manager, providers, insurers, or even patients could report non- compliance. For example, if insurers are providing available coverage but not seeing patient utilization, and the patient makes a complaint for denial or delay of services then this would cause for that mental health provider or facility to be reported where claims would be investigated and determined if and what the penalties will be. Most penalties will cause for immediate correction in order to fulfill treatment or services. Penalties may also cause for fines, audit of practices within facilities, and/or be deemed inoperable until violations are corrected. Providers must document all instances so recommendations can be made for further treatment. When patient-doctor questionnaires are assessed, most electronic health systems can recommend next steps for treatment that extend to behavioral facilities for mentally ill patients. Caregivers who oversee mental health patients also assume full responsibility. They are held to compliance standards by making sure prescribed medicines are monitored, doctor visits are completed, and there is full engagement in patient care at home and at behavioral health facilities, and failure to comply results in a penalty. The stakeholders identified in this solution are: patients, providers, insurers, care givers, health and administration agencies, advocates/ social workers, and review committees.

Increasing social awareness on mental health issues starts with integrating mental health care as a necessity along with primary care to “reduce the resort of hospitals to improve overall quality of life” (Lorant, 2016) through changed behaviors and treatment. This means that stakeholders must prioritize to “contribute to understanding the complex relationships between policy plans, processes of action, actual outcomes, and, finally, the effectiveness of such policy reforms” (Lorant, 2016).