Mental Health Coverage in the U.S

Mental Health Coverage in the U.S

Mental health is an under treated health issue that is rapidly growing. Unfortunately, not only is medical healthcare an issue in society today financially, but also with costs not covering nearly enough for mental health as well, an upward rate in mentally ill people has become at an all time high. “Among the 8.9 million adults with any mental illness and a substance use disorder, 44 percent received substance use treatment or mental health treatment in the past year, 13.5 percent received both mental health treatment and substance use treatment and 37.6 percent did not receive any treatment.” (APA, 2016)  Mental health budget in the United States in 2012 was about 5.6% of the overall national health-care expenditure. Not only is this budget extremely too low, the actual access to mental health care is worse than any other type of care. (Kliff, 2012) This being stated, not only is budget a primary issue in mental health treatment, but there is also a barrier in actually seeking the care. These two significant factors create a huge wall in the realm of treating any for of mental illness. Through proper management and prompt treatment, insurance providing adequate funding to treat mental illnesses both chronically and acute, it can drastically decrease the long-term effects of people and society as a whole. The issue is there are many undertreated mental illnesses. Because they are under or not treated at all, the long term cost and medical effects on the person don’t only effect the person, but the family, their friends, society, and even financially for society as a whole. This stream of effects on society lead to long term care of these patients which costs more in the long run: both financially and physically. One minor mental ailment being untreated leads to a more significant issue ultimately effects a large population at whole.

Advocacy and Campaigns for Mental Health

There are many areas of support and advocacy for mental health. Support groups, facilities, therapies and campaigns head strong to advocate for those who suffer from mental illness: minor or chronic. A common place where people seek support is the Internet. A group called Mental Health America (MHA) is an avid support group where people who suffer from mental illness can find resources, support chats, support groups, and health advocacy and [policy. (MIA 2016). Another very common support site is NAMI; National Alliance on Mental Illness. This site has a strong find of support in a versatile area of mental illness along with a very strong advocacy for mental health: minor, chronic, suicidal, diversity, addiction, and more. (NAMI 2016) Active Minds is a group that provides national mental health awareness as well providing movements and national significance. In the campaign there are things such as National Day Without Stigma and Eating Disorder Awareness Week (Active Minds 2016). These awareness campaigns are enforced to recognize illnesses that are often seen as embarrassing or disgraceful. This allows people who suffer from these illnesses have a form of acknowledgement and understand by society that these are in fact real and scary illnesses. “As part of our mission, we require of ourselves a commitment to work toward the recognition and elimination of prejudice and discrimination, especially those that have traditionally impinged upon culturally competent mental health services.” (Active Minds, 2016) Unfortunately, although support plays a strong role in what can be such a dark illness, this does not treat the issue at hand. There is still a very large lack in financial funding and insurances to adequately provide necessary treatment to actually treat these illnesses.

Purposed Policy Regulation

Creating a policy allowing mental health expenditure to be just as significant as medical care could great impact the overall health of our society today. Mental health, when untreated, not only leads to further health complications and comorbidities, but it also can pose a threat to others. If we treat mental illness promptly and adequately we decrease the likelihood of poor outcome and readmission treatments. In doing this, we simply create a regulation, or alter it rather, to create mental health as an equal to medical care. If insurance coverage could decrease the stipulations on mental health care, increase range of treatment, and acknowledge co-pays and out of pockets costs similarly to those of medical care, we could not only decrease the comorbidities and long term effects that are rapidly growing today, but we can also increase the likelihood of increasing mental healthcare in the U.S. overall. Mental healthcare is hard to find because it’s cautiously used, but it’s cautiously used because it’s rare and expensive. This acts a double negative with no positive outcome.

Existing Barriers

Our medical care system thrives off of making money. This is why we have seen an increase in medical care and billing. Treatments are advancing, but with this advancement comes lab and study work which costs money. Considering medicine is ever changing, these rates will likely continue to increase as we grow. In the U.S. we have a variety of state specific laws that hinder the level of mental health coverage and treatment. “Some state parity laws–such as Arkansas’–provide broad coverage for all mental illnesses. Other state parity laws limit the coverage to a specific list of biologically based or serious mental illnesses.” (NCSL, 2015) Although there is a vast amount of specification per state, there are also requirements that can play in favor of this. There is a large list of state mandating treatments for behavioral health issues. If there is mandating, then the biggest obstacle is funding or coverage. Unfortunately these mandated offerings tend to be geared more to a substance abuse category rather than mental illness.

Although there are Mental Health Parity Acts in place that should be allowing a better treatment system, there are still financial barriers because the broad coverage has many hidden restrictions that insurance companies tack on. “The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. MHPAEA supplements prior provisions under the Mental Health Parity Act of 1996 (MHPA), which required parity with respect to aggregate lifetime and annual dollar limits for mental health benefits.” (USDOL, 2016)

Influencing Change

When influence change in a drastic area such as health care and policies, it must be taken in such a matter that is thoughtful and supported by evidence and society. Like Kingdon’s model (1995), there must be an approach at concepts related to policy, problem, politics, and window of opportunity. (Milstead, 2004) In approaching research in a manner of these four listed concepts, each important variable factor is touched and creates that window for opportunity to be utilized at its prime overall enhancing the likelihood of positive outcome. The three legs of lobbying also play a vital role on creating a solidified influence. Firstly, a lobbyist: having a professional mental health advocate for implementing the change. In having someone with a strong mental health professional background voice the need for change and its benefits, suddenly impact on reason is increased and others are likely to relate or support the change. Next, networking with a grassroots lobbyist such as a medical board member, political figure whose opinion and vote is seen as extra sensitive is imperative to have proper advocacy from vote. In this case, a mental health board member or insurance advocate board member is primary for said role. Thirdly: the leg role of money. Money influence change so significantly. If the policy advocacy is geared towards financial up bring and long-term financial growth, policy makers and legislators are keener to seeing perspective on this change. This can be done through graphing and small evidenced based practices comparisons. (Milstead, 2004) Because money is often an obstacle in these legislative processes, overcoming this is simply done by promoting through the right means. Is promoting the policy was gear primarily to healthy outcomes; it would not be a recognized or acknowledged as focusing it towards long term financial uphold.

Ethical Considerations

Psychiatric care is a much under-seen area in healthcare. Because mental health is considered separate from healthcare and run into its own category of copays, coverage, and degree of treatments, it tends to be over seen, under treated, and often times completely neglected all together. When advocating a higher level of psychiatric treatment and coverage different ethical dilemmas can arise in consideration to the fact that psychiatric treatment is typically unknown or unfamiliar to many. Because psychiatric health in unknown it can raise a stir of conflict to put more money into treatment. To decrease this outcome, educating on the importance and long-term outcome of mental health is important to incorporate into advocacy campaign. Provision seven of the Code of Ethics states “The nurse assists in advancement of the profession through contributions to practice, education, administration, and knowledge development.” (Slate, M. 2015) This provision sets an example that nurses must advocate through contributing knowledge and education. This is one way to decrease barriers in advocacy. Another ethical consideration in this campaign would involve the privacy and dignity of psychiatric patients. Although there is a strong advocacy being held to benefit people or patients with mental illness and psychiatric issues, the champagne will express a lot of vulnerable topics including that of which these psychiatric patients go through. Often times, psychiatric patients are ashamed, embarrassed, or in denial of their health condition. It is important, as an advocate, to respect the dignity of our clientele. Approaching this topic must come delicately and strongly consider that of the people affected and surrounding while still fully educating others on the unknown. This can be approached in an educational manner with facts while delicately and consensually adding in personal experiences.

Ethics and Lobbying Laws

Ethics that tale precedence inn this advocacy campaign begin with provision seven to which expresses that nurses contribute through involvement and leadership in education. This stands out in this campaign strongly considering the stemming issue of psychiatric illness seems to be undereducated. Provision eight also plays a great role in this advocacy campaign in that it is focused on nurses collaborating though, to, and with the public. Because this campaign effects society as a whole and directs to s specific population that stems to many others, involving the public will not only strengthen the campaign but also benefit in educating society. (Slate, M. 2015)  In an advocacy campaign the goal is to promote and support change in status of a current issue or trend. This champagne is geared to advocate for more money to be put into mental healthcare. Lobbying is “The act of attempting to influence business and government leaders to create legislation or conduct an activity that will help a particular organization.” (Business Dictionary, 2016) Lobbying can become an issue in that when advocating for a funding insurance and mental health the change is governmental. It must be seen through government officials and escalated. According to the Lobbying Act “Make or promise a campaign contribution to (or solicit or promise to solicit campaign contributions for) a legislator or the Governor when the legislature is in regular session. The prohibition may extend past the end of regular session with regard to the Governor if regular session legislation is pending approval or veto.” (AZSOS, 2013) It is important to focus an appropriate approach to this campaign a start at a more local level to allow appropriate escalation by the appropriate people.

Special Ethical Challenges

When advocating for mental health, again, clientele privacy and dignity are a primary ethical challenge. In one sense, expressing the hardship and experiences of psychiatric clientele is a sure way to exploit the need for further and increased care, however this comes at a great cost to the clienteles privacy and dignity. Of course consensual expression would be achieved, yet as a nurse, advocating for the dignity and personal outcomes of the patient must be ignited primarily. It is important to remember that the population being addressed has been severely effected by this and the champagne can act as a constant reminder of the issue at hand. Even though the campaign is for good cause, as a nurse it is important to always focus on the obligation to our patients and their feelings.


Overall, mental health is under treated causing long-term ailments and outcomes for the individual, society, and the financial pull of the U.S. overall. Through creating a policy that treats mental health just as medical health is we alleviate the downward spiral of comorbidities, long-term complications, and society as a whole. With mental health being under treated, there is too significant of a readmission rate and short term treatment going on causing long term societal and financial burden on our economy and society. Nursing is a profession chosen to be focused primarily to the advocacy to patients and their loved one’s. Nurse’s work according to a standard Code of Ethics, which helps protect patients and their privacy as well as enhances advocacy that creates an entrusting nurse and patient relationship. In all circumstances, the privacy, trust, and dignity of the patient must be a main focus. Nurse’s work towards providing their patients with dignified and honorable care that is focused to their primary needs. Campaigning to advocate for a specific clientele such as psychiatric patients, it is important to address delicately and focus on respecting the clientele and their life. This advocacy campaign is gear to increase the funds that are spent on psychiatric patients to allow more availability to psychiatric needs. This will allow more prompt treatment, more likelihood in diagnosing psychiatric issues. By providing appropriate funds and decreasing copays on psychiatric healthcare there is an increase in prompt treatment thus decreasing long term costs which ultimately effect government spending more. When advancing to a more government level, it is also important to prioritize appropriately and according to lobbying laws.


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