Approximately one in four adults suffer from a diagnosable mental disorder in a given year, according to the National Institute of Mental Health. Despite the prevalence of mental illness, health insurance plans tend to be more restrictive in their coverage in comparison to somatic, or bodily, illnesses. A 2009 report by the National Alliance on Mental Illness, an advocacy organization, gave the nation's mental health services a D grade, asserting, "We are painfully far from the high-quality system we envision and so desperately need." Provider coverage of mental health services varies from plan to plan and across states.
Outpatient Therapy
Outpatient services include consultations with psychiatrists, psychologists, social workers or other mental health professionals. Appointments can take place in a hospital, clinic, private office, and sometimes, in the home. This is the most basic level of care and is usually included in insurance plans that include mental health coverage. Approximately 85 percent of employer-sponsored health insurance policies cover outpatient therapy and the average benefit package includes 30 outpatient visits per year, according to data reported by the National Mental Health Information Center.
Inpatient Psychiatric Care
Inpatient treatment is provided in a hospital or mental health facility, 24 hours a day. In cases where outpatient treatment is not sufficient or the patient is believed to be a danger to himself or others, the patient is committed to a hospital for testing, diagnosis and treatment. The types and extent of care depend on the patient's health and the coverage provided by the insurer. On average, private insurance policies include 30 days per year of inpatient care.
Nonhospital Residential Care
Some plans also cover 24-hour a day treatment in facilities not affiliated with a hospital. These can include treatment centers for specific illnesses, such as eating disorders or addictions. It is up to the treatment center whether it accepts specific insurance plans. Approximately half of private plans cover such services.
Intensive Nonresidential Care
Many hospitals, treatment centers and clinics offer intensive treatment on an outpatient basis that can include case management and psychosocial rehabilitation. According to the National Mental Health Information Center, "Case management involves coordinating and integrating services for patients who require services from two or more providers. Psychosocial rehabilitation includes pharmacologic treatment, social skills training, and vocational rehabilitation." Approximately 60 percent of employer-sponsored plans include such coverage.
Crisis-related Services
Crisis-related services are used to respond to emergency situations and can either offer immediate, short-term care or serve as a point of transition into longer, more intensive care. Services include evaluation and assessment, crisis intervention and plans for follow-up care. According to information provided by the Surgeon General's office, crisis services can include "telephone hotlines, crisis group homes, walk-in crisis intervention services, runaway shelters, mobile crisis teams, and therapeutic foster homes when used for short-term crisis placements." Crisis-related services are the least covered of mental health benefits.
References
- National Institute of Mental Health: Statistics
- Mental Health: A Report of the Surgeon General
- SAMHSA's National Mental Health Information Center: Special Report: Improving Mental Health Insurance Benefits Without Increasing Costs
- National Alliance on Mental Illness: The State of Public Mental Health Services Across the Nation
