Insurance covers more mental health care than many people may realize, and more people soon will have the kind of health insurance that does so.
In the days following the Newtown, Conn., school shooting, parents and politicians took to the airwaves to make broad-based proclamations about the sorry state of mental health care in America.
But a closer look reveals a more nuanced view, with a great deal of recent legislative progress, as well as plenty of coverage gaps.
The stakes in any census of mental health insurance coverage are high given how many people are suffering: 26% of adults experience a diagnosable mental disorder in any given year, and 6% of adults experience a seriously debilitating mental illness, says the National Institute of Mental Health. And 21% of teens experience a severe emotional disturbance between ages 13-18.
According to this year's Society for Human Resource Management survey of 550 employers of all sizes, 85% offer at least some mental health insurance coverage.
For now, some people without health insurance or who buy it on their own may avoid purchasing mental health coverage, too.
This happens for many of the same reasons that there has historically been less mental health coverage than there has been for other illnesses. The earliest objections among insurance providers and employers were around whether mental disorders existed at all, says Howard Goldman, a professor of psychiatry at the University of Maryland school of medicine.
Then there were questions about whether treatment actually worked.
Next, concerns arose over cost and how often people would avail themselves of costly mental health treatments.
But a subset of adults who have good insurance coverage still avoid treatment for mental illness, according to Edward A. Kaplan, senior vice president and national practice leader for The Segal Co., a benefits consultant that works with many unions.
"Culturally, a lot of people driving trucks don't believe in it and suffer through," he said. "And a lot of transport unions don't trust employers and think they will look at it and use it to retaliate against the workers."
For many of the people who do have mental health coverage, there is now a bit more of it at a lower cost than there might have been five years ago.
That's because a 2008 federal law requires employers with more than 50 employees that do offer mental health coverage to have no more restrictions and no higher costs for it than there are for physical injuries or surgery.
The combination of parity and expanded care is crucial, according to Anthony Wright, the executive director of Health Access, a consumer advocacy organization in California.
After all, parity doesn't do much good if the mental health coverage need only be equivalent to a lousy health insurance plan that covers very little.