Tuesday, October 14, 2008

Eco-Anxiety: Parity at Last?

On October 3rd President Bush signed the Mental Health Parity Act of 2008. What does this act mean to us as mental health practitioners?

1. It means mental health coverage will be extended to about 113 million people

2. Employers are not required to provide mental health coverage, but those that offer health coverage must offer equality between mental and physical health care.

3. By equality, the act specifies:

- Co-pays, deductibles, and out-of-pocket costs cannot be greater for mental health coverage

- Separate limitations for treatment cannot be applied for mental health coverage, i.e. limits for out-patient visits to treat a child's behavioral disorder cannot be less than outpatient visits for treatment should he break his leg.

4. Criteria for a health plan determining whether a mental health procedure is medically necessary must be made available to patients upon request.

5. The act does not define what a mental illness is, leaving that up to various plans and, of course, existing state law, but it is generally thought that it will apply to disorders included in the Diagnostic an Statistical Manual of Mental Disorders.

So what does this mean for eco-anxiety? Well, on the one hand, since eco-anxiety arises from well-placed concern about environmental problems and the economic fall-out that's occurring across the country, it isn't necessarily a mental "illness," but, on the other hand, as many of us have already seen, dealing with problems arising from these concerns can most certainly make one ill, either physically and/or mentally.

Note recent news reports such as the 90-year old woman who shot herself upon facing eviction from her home. Or the man who lived not far from where I live who killed his entire family and then shot himself due to consequences from the recent national economic meltdown.

Generally it is not the source of the distress that determine if it's effects are covered under a health plan but its seriousness. If one's stress, be it from economic, marital, environmental or other causes, lead to development an ulcer, certainly that ulcer would be treated as a medical condition. Thus an equal case can be made that if distress from eco-nomic issues results in severe anxiety, depression, substance abuse, PTSD, or any other ailment that appears in the DSM, then parity would suggest it should be covered equally.

I'm interested in your thoughts on this interpretation. Of course, we must monitor how this act actually plays out plan-by-plan and state-by-state. Please let's share our experiences as the implications of this act unfolds.

E-mail me at sewards@frazmtn.com or leave a comment below with your thoughts or any developments you encounter. I'll be post them immediately. Let's work together to be sure our clients get the best possible care. Sadly there is and will most certainly be ample need.

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