It took a long time, but the Federal Parity Law is now in effect and health insurance plans should be covering mental health issues equal to issues related to the body.  It makes sense, after all the brain is part of the body!

Below is an excerpt from the most recent “E-News” from the National Alliance on Mental Illness.

For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.

The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.

• View NAMI’s factsheet on the new law
• View a Powerpoint presentation on the new law

Is Your Health Plan in Compliance With Parity?

NAMI is seeking information from individuals and families on how the new law is working. This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.

As mentioned in a previous blog, the Diagnostic and Statistical Manual is in the process of being updated and now is the time to register your comments.

The Diagnostic and Statistical Manual (DSM) is used by psychiatrists and other mental health professionals to classify and diagnose mental disorders in children and adults. The DSM has historically had a very significant impact on the treatment of mental illness and on the payment of mental health treatment and related services. A committee created by the American Psychiatric Association (APA) has been working on revising the DSM to reflect current scientific understanding about mental disorders. Earlier this week, the APA posted the draft of the revised DSM, known as the DSM-5. The draft DSM-5 can be found at the website: http://www.dsm5.org/Pages/Default.aspx

For the next two months, the APA is seeking input from individuals, family members, clinicians and others about the proposed changes contained in the DSM-5. The deadline for submitting these comments is April 20, 2010. I will be providing you with more information, including NAMI’s reactions to the proposed changes, in the coming days and weeks. Meanwhile, I encourage you to visit the DSM-5 Web site, familiarize yourself and your members with the proposed changes and submit comments as appropriate. NAMI also wants to hear your reactions and comments. Post your feedback on the National Alliance on Mental Illness website at www.nami.org

NAMI wants to hear from you.

When my son was diagnosed with schizophrenia at the age of 18 we had a difficult time accepting it.  Once a person is labeled with a serious mental illness it can change their lives forever. I do not take this subject lightly. Mental illness is serious, but with proper treatment people do recover and live productive, happy lives and the earlier the intervention, the better.

Diagnosing mental illness is not something most physicians take lightly either. Because of the stigma sometimes the diagnosis can be delayed for decades. Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives.  The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.

According to some estimates, the diagnosis of bi-polar in children under 18 has risen by 4000% since the 1990’s. Obviously that has caused a lot of controversy. Other disorders like autism, anorexia, binge eating, and ADHD have also skyrocketed. There are hundreds of reasons why people believe this is happening and I don’t have the space here to go over all of them, but the fact remains that many people do suffer needlessly for decades before seeking or receiving proper treatment for their disorder.

It’s a very complicated issue and one the new DSM-V is attempting  to address. In the draft version of the manual which is a psychiatrists diagnostic bible, instead of bi-polar, clinicians will be able to use a new diagnosis called “temper dysregulation disorder” for a child over six years old. (the mania of bi-polar can manifest as uncontrolled temper or irritability in children.) Unlike bi-polar, it would not be classified as a life-long illness.

Local Tucson childhood psychiatrist, Dr. Ann Lettes addresses some of the issues in her statement to me by saying, “Whether the official label is Mood Disorder NOS, Bipolar Disorder NOS, or “Childhood Temper Dysregulation Disorder with Dysphoria” is unlikely to affect how we treat it. If the new diagnosis is reimbursible by insurance then I would likely use it because of the stigma around “Bipolar Disorder” and the impact that diagnosis can have on future employability, insurablility, and eligibility for military service. My concern is that clinicians who are not Psychiatrists will be diagnosing misbehaving children whose parents need parenting training more than the children need medication with a dysregulation disorder. This would also dilute the power of the diagnosis for the children who truly have severe physiologically based mood regulation problems.”

Dr. Michael First, a professor of psychiatry at Columbia University who edited the 4th addition of the manual is quoted in the New York Times as saying “Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled”

The bottom-line is that psychiatric illnesses are not only difficult to live with, they can be difficult to diagnose and treat. Stigma and mis-information cause people living with and families dealing with these disorders to not seek treatment. Insurance companies complicate the issue even further by requiring answers that fit nicely into a little box in order to provide coverage. Sometimes there are no clear cut answers.

Before the new DSM-V is published field trials and a risk/benefit analysis on the changes are being researched. To see a draft of the manual you can visit the website at www.DSM5.org

Viewers to the website will be able to submit comments until April 20, 2010.