Effects of Mental Health Benefits Legislation

Abstract

Context Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Evidence acquisition Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Evidence synthesis Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Conclusions Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence is limited for other mental health outcomes.

Policy Levers to Promote Access to and Utilization of Children’s Mental Health Services: A Systematic Review

“…Further, our methods limited our ability to probe for the mechanisms by which policy levers influenced access and utilization outcomes. For example, state or federal mental health benefits legislation could reduce mental health coverage restrictions, in turn leading to reduced family out-of-pocket costs paid for services and subsequent increase in service utilization (Sipe et al 2015). Although this is a common shortcoming in existing literature (Moulton et al 2009; Shonkoff 2017), future studies could disentangle these mechanisms to facilitate causal inferences.…”

“…For PubMed, Medical Subject Headings (MeSH) terms were also included. Search terms were tailored to each database, informed by the literature (Miles et al 2010; Sipe et al 2015; Spencer and Komro 2017) and based on four dimensions of interest: (a) problem or condition (e.g., anxiety, conduct disorder); (b) treatment (e.g., group therapy); (c) categories or intended outcomes of policy levers of interest (e.g., availability); and (d) treatment target (e.g., caregiver, teacher) (Table 1). …”

“…To capture other potential policy evaluations related to psychological services, we also conducted a set of broad searches in each database. These broad searches revealed two additional policy levers with eligible studies: mental health parity (defined as any mandate to insurers dictating coverage and/or reimbursement for mental health and substance abuse services on par with that for physical health) (Sipe et al 2015) and public health insurance (defined as any form of healthcare designed to meet healthcare needs drawing from a publicly managed fund). We underscore that studies within the mental health parity policy lever category could include both evaluations of mental health parity laws as well as single-condition (e.g., autism spectrum disorder) mandates.…”

Recommendation for Mental Health Benefits Legislation

“…The Task Force finding is based on evidence from a systematic review 6 of 30 studies reported in 37 papers (search period, 1965-March 2011). Of these, 28 studies examined the effects of state or federal mental health parity legislation or policies, and two studies examined the effects of state-mandated coverage for mental health and substance abuse care; these studies generally found favorable effects.…”

“…The systematic review 6 identified several evidence gaps that need to be addressed in future studies of mental health benefits legislation. There is limited research investigating the effects of mental health benefits legislation on mental health outcomes.…”