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NADD U.S. Policy Update (from the NADD Bulletin Volume VII Number 2)Complete listing
Mental Health Parity: Will This Be the Year?
Anna L. Zendell, MSW School of Social Welfare, University at Albany,
State University of New York
NADD U.S. Public Policy Committee
Access to comprehensive mental health services has long been a
struggle for people with dual diagnoses. Health insurers typically
provide less coverage (visit caps, higher co-payments, and higher
deductibles) for mental health and substance abuse than for general
medical care. This inequity can lead to adverse outcomes. Many people
with co-occurring developmental disability and mental disorder,
particularly children, are covered under their parents' insurance
plans and regularly face this disparity.
The federal government and most states have passed laws to restrict
these practices. The Mental Health Parity Act (MHPA) of 1996
prohibits insurers from placing lifetime and annual dollar limits on
mental health benefits. By October 2003, 46 states had enacted their
own parity legislation (NCSL, 2003), though most require only limited
parity. Not all states cover substance abuse and many do not cover
the full spectrum of psychiatric diagnoses. Arkansas, Maryland, New
Hampshire, New Jersey, and New Mexico offer comprehensive parity for
most mental illness (NCSL, 2003).
The MHPA requires that dollar limits for both medical and mental
health coverage be identical when both types are offered as part of a
group insurance plan. It does not apply to plans with fewer than 51
workers, or to health insurance coverage obtained through the state,
welfare assistance, or on the individual market. It does not affect
companies that do not offer mental health benefits. The MHPA contains
loopholes that have spurred congressional leaders and advocates to
seek more comprehensive parity legislation. For example, the General
Accounting Office found that plans cut costs by imposing stricter
limits on medications and outpatient mental health care (Kjorstad,
2003). The law also did not provide a definition of mental illnesses
to be covered, allowing insurers to defray costs by limiting types of
psychiatric disorders covered.
Many advocates are frustrated by the lack of improvement in mental
health care access and utilization. A growing body of evidence
suggests that comprehensive parity is affordable and would improve
the lives of people with psychiatric disorders. The U.S. Surgeon
General (1999) reports that, in states requiring parity, cost
increases were nearly imperceptible as long as the care is managed.
An actuarial analysis by the National Advisory Mental Health Council
estimates that full parity would increase premiums by only 1.4%
(Feldman, Bachman & Bayer, 2002).
The Senator Paul Wellstone Mental Health Equitable Treatment Act
(MHETA) of 2003, presently under consideration in both the House and
Senate, is intended to sharply reduce insurance disparity. Originally
introduced in 2001, the MHETA would prohibit group plans from
imposing treatment limitations or financial requirements on mental
health benefits unless the same requirements were placed on general
medical benefits. It would require coverage for all categories of
mental disorders under the DSM-IV and close loopholes on time
limitations for coverage, deductibles and co-payments. Employers of
fifty or fewer people would still be exempted. Standard managed care
tools such as prior authorization, preferred within-network coverage,
and utilization reviews would be permitted to maintain affordability
for employers and accountability among providers.
The MHETA would greatly reduce insurance inequity, sharply reducing
fears for many individuals and families of exceeding insurance caps
before the person stabilizes or receiving less effective intervention
due to insurance. This landmark legislation has the support of
President Bush, over two-thirds of the Senate, half of the House, and
advocates from most disability groups (Kjorstad, 2003). While the
MHETA does not cover Medicaid or Medicare, it may be a stepping-stone
to passage of parity legislation for these two programs over time.
Nearly 300 national organizations support this legislation, including
The NADD. Despite this broad-based support, business and insurance
lobbies have consistently blocked passage, citing fears of dramatic
cost increases. While some factions appear willing to compromise,
many compromises would involve covering only the most
"severe" mental health disorders, a move that would limit
diagnoses covered for persons with co-occurring disorders.
This year will be crucial for the MHETA. Senators Domenici (R-NM) and
Kennedy (D-MA) are planning to move the MHETA to the full senate for
a vote early this spring. Advocates must follow the bill through both
houses of Congress to assure that it is not weakened or set aside.
Advocacy organizations, including The Bazelon Center, National
Alliance for the Mentally Ill, The ARC of the US, and National Mental
Health Association, provide action alerts informing people how to
influence important legislation, such as writing or telephoning
congressional representatives. Additionally, the Parity Hotline
(1-866-PARITY4) provides direct access to the Capitol switchboard and
connects directly to senators and representatives.
The importance of contacting local congressional representatives
cannot be emphasized enough. Passage of the MHETA would help dispel
the societal norm that people with mental disorders, particularly
those with co-occurring developmental disabilities, are "less
deserving" of treatment than those with physical illnesses and
would dramatically improve treatment options for persons with dual
diagnoses.
References:
Feldman, S; Bachman, J. & Bayer, J. (2002). Mental health parity:
a review of research and a bibliography. Administration and Policy in
Mental Health, 29(3), 215-228.
Kjorstad, M.C. (2003). The current and future state of mental health
insurance parity legislation. Psychiatric Rehabilitation Journal,
27(1), 24-42.
National Conference of State Legislators. (2003). Mental health
parity. State Health Lawmakers' Digest 1(2). Retrieved from http://www.ncls.org/programs/health/forums/shld/23.htm.
US Department of Health and Human Services (1999). Mental health: a
report of the surgeon general. Rockville, MD: National Institute of
Mental Health.
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Upcoming Conferences:
September
Ohio State 10th Annual MI/DD Conference , Mental Health Aspects
–Treatment & Support (September 18 & September 19, 2012)
Columbus, Ohio
October
NADD 29th Conference & Exhibit Show, (October 17 - 19, 2012)
Denver, Colorado
October 2013
NADD 30th Conference & Exhibit Show, Baltimore MD (October 23 -
October 25, 2013)
Complete Calendar |
New Educational Products:
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 Intellectual
Disability and Mental Health: A Training Manual in Dual Diagnosis
Sharon McGilvery, Ph.D. and Darlene Sweetland, Ph.D.
With the release of this book, Drs. McGilvery and Sweetland share
decades of experience working with individuals diagnosed with an
intellectual disability and co-occurring psychiatric disorders. Their
well-practiced approach takes into account the extremely complex
nature of working with dual-diagnosis. The authors provide
in-depth information about the diagnostic process, hands-on treatment
considerations, and their experience training thousands of people to
work passionately with these individuals. An important
contribution is their approach to addressing complicating factors in
identifying appropriate psychiatric diagnoses, as well as the problem
of the underreporting of psychiatric symptoms and disorders. Finally,
those working in a variety of contexts with these individuals will
benefit from the innovative approaches of looking at treatment and
intervention strategies that can be immediately implemented. 264 pages
Details:
ST11-053B
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 A
PRACTICAL GUIDE to Assessing Medical Issues Associated with
Behavior/ Psychiatric Problems in Persons with Intellectual
Disability – Revised in 2011
Ann R. Poindexter, M.D.
This book discusses medical/medication issues which may present as
behavioral/ psychiatric problems in individuals with intellectual
disability. Three self-directed instructional courses and
several illustrative case histories are included. 110 pages\
Details:
DA05-021BR
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Psychotherapy for Individuals with Intellectual Disability
Edited by: Robert J. Fletcher, DSW, ACSW
This book provides the reader with insightful and useful ways to
provide psychotherapy treatment for individuals who have intellectual
disability (ID). It brings together all three modalities
(individual, couple, and group), and a variety of theoretical models
and techniques are discussed. The first section, Individual
Therapy, offers a variety of approaches and techniques including
dialectical behavioral therapy, positive psychology,
mindfulness-based practice, and relaxation training. Also included in
this section are chapters on specialty populations including victims
of abuse, people who have Autism Spectrum Disorder, and people in
mourning. The second section is a chapter on group therapy addressing
trauma issues. The third section is on family and couple therapy. The
fourth section covers chapters on research, ethics, and
training. The individual authors are respected authorities in
the field of providing psychotherapy treatment for persons with ID
and all have contributed to the professional literature.
This book is a major contribution to the effort to make psychotherapy
available to individuals who have ID and should serve to further
stimulate interest in the provision of psychotherapy treatment for
individuals who have ID co-occurring with significant mental health problems.
NADD # CT11-051B Details
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 Comprehensive
Competence-Based Parenting Assessment for Parents with Learning
Dificulties and Their Children
Maurice Feldman, PhD, Marjorie Aunos, PhD
This book presents an innovative, empirically-supported approach to
assessing parenting capacity of parents with learning difficulties
that can lead to more humane, fair and accurate child custody
decisions. The authors are leading researchers and
practitioners in this field haing worked with hundred of these
families. Many professionals working with these families
recognize that the current parenting capacity assessment approaches
are based on outdatd and invalid assumptions and methods. This
book addresses the unique assessment needs of these families and
includes detailed background information, rationales and methods.
NADD # DA10-050B Details
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 Working
with People with Challeging Behaviors: A Guide for Maintaining
Positive Relation
Nathan Ory
The material in this book introduces general practices
and specific solutions to behavior problems that will work with
people who display difficult and challenging behaviors regardless of
who they are. It is especially suitable for working with
individuals who have developmental or intellectual disabilities
coupled with a behavior disorder. The methods also apply to the
person with emotional or psychiatric disturbances, or another serious
mental health problem. Finally, they are helpful in providing
support to elderly individuals who display challenging behavior.
NADD # ST10-049B Details
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Human Needs and Intellectual Disabilities: Applications for Person
Centered Planning, Dual Diagnosis, and Crisis Intervention
Steven Reiss, Ph.D.
Human Needs and Intellectual Disabilities identifies the 12 human
needs most relevant to the lives of people with intellectual
disabilities, autism and related developmental disabilities. It
includes detailed, practical suggestions for caregivers or parents
interested in the happiness, quality of life, and self-determintion
of their loved ones or consumers. The book includes detailed,
practical suggestions for reducing episodes of challenging behavior
and psychiatric symptoms in people with a dual diagnosis
(intellectual disabilities and mental illness). It shows how to
substitute the language of individuality (e.g., "friendly
person") for the language of disability (e.g., "person with
disability"). It also reduces the tendency of planners to
confuse their own value system for that of the consumer. The
book includes scholarly reviews of dual diagnosis literature on
mental illness, prevalence, and assessment.
NADD # DA10-048B Details
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Positive Identity Development
Author: Karyn Harvey, PhD
Positive Identity Development is an exciting new approach to
treatment for individuals with intellectual disabilities. This
book provides a new theoretical perspective on treatment along with a
variety of innovative tools. It rejects reducing adults with
intellectual disabilities to a mere compilation of their behaviors
and promotes the use of a positive, therapeutic approach to each
unique individual. Psychologists, social workers and therapists
should be able to use the tools presented in this book to directly
enhance the effectiveness of the treatment they provide to adults
with intellectual disabilities. This book promotes well-being on
every level and explores a broad range of issues relevant to the life
and mental health of adults with intellectual disabilities
Mbr Price: $34.95
Non-Mbr: $39.95
NADD #CT09-047B Details |
 Down
Syndrome: When to Worry about Mental Health and What to Do About It
Robin Friedlander, M.D. & Peter Johnson, Ph.D.
NADD # FI09-044B Details |
 Working
with People who have Intellectual Disability and Behavioral
Problems: A Self-Study Guide for Interdisciplinary Team Members
Ann R. Poindexter, M.D. & Paul D. Kolstoe, Ph.D.
NADD # ST09-045B Details |
Multi-Media CDs of NADD 25th Annual Conference Presentations
Presentations recorded at NADD 25th Annual Conference are available
as multi-media CDs. These CDs contain the video and Power Point
from conference presentations and are a great tool for training
yourself and your staff. To order, or for additional
information, click here.
Community Networks of Specialized Care: Building Community
Capacity through Training and Education Lisa Holmes, Liz
Froese, MSW, Rosanne Stein, LLB, BSc, Sandi Bricker
NADD Competency-Based Dual Diagnosis Certification Program Robert
Fletcher, DSW, ACSW, FAAIDD; Donna McNelis, PhD; John McGonigle,
PhD; Kathleen Olson, PhD; Jarrett Barnhill, MD
Autism Spectrum Disorders: Separating the Data from the
Myths Ann R. Poindexter, MD
Diagnostic Systems for Use with People with ID Luis
Salvador-Carulla, MD, PhD, Robert J. Fletcher, DSW, ACSW, FAAIDD,
Sally-Ann Cooper, MD
The price for the above multimedia is: Member:
$49.95 Non-member: $59.95
To order, or for additional information, click
here.
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