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3 Decades of Legislation and the Changing View on Mental Health

3 Decades of Legislation and the Changing View on Mental Health

The past three decades have seen a profound change in legislation regarding mental health treatment and policies

The past three decades have seen a profound change in the way that the government has viewed mental health. A review of legislation related to the mentally ill will outline the shift that has taken place in the way that the government and society as a whole have viewed this population.

The Mental Health Systems Act

President Jimmy Carter took the first important steps in changing the national conversation about mental health and those suffering from a mental health condition with the passage of the Mental Health Systems Act in 1980. Even though this act was repealed in 1981 after Ronald Reagan took office, research conducted during the creation of the Mental Health System Act uncovered very significant findings:

  • Many of the seriously ill were dependent upon generic entitlements
  • A large section of those suffering from a mental health condition found it impossible to maintain regular employment
  • Medicaid, Supplemental Security Income (SSI), and Section 8 Housing are often the only way these individuals are able to survive.

As a result of the repeal of the Mental Health Systems Act, the federal government moved into the background of the mental health conversation. Unfortunately, many individuals were deinstitutionalized without any type of community safety net over the next decade or so, and ushered into environments they were ill-equipped to manage, due to a dearth of mental health resources. This gave rise to an increase in homelessness among those with mental health conditions, along with a general societal misperception of this population.

The Role of Pharmaceutical Advances and Managed Care

Major breakthroughs in the understanding of addiction and neuroscience brought a shift in the general view of mental health conditions. Serotonin reuptake inhibiters (SSRIs) such as Prozac were released, and were pitched to the public as part of a new normal. The commercial messages of these products can be summarized as “depression is normal and treatable,” and this message was accepted by the public. This positive development was a profoundly significant shift, as it was the beginning of accepting those with mental health conditions as similar to individuals with physical illnesses.

At the same time, managed behavioral health care became prominent. At its core, managed behavioral health care reduces the cost of mental health care services by the utilization of community care options such as psychiatrists over extended hospitalizations. While these treatment options may not be beneficial for those with very significant mental health conditions, on the whole managed behavioral health care has done much to make these services more affordable and more acceptable.

Americans with Disabilities Act and the Mental Health Parity Act

The 1990s saw two significant pieces of legislation work together to further change the social impacts of mental health conditions. The American with Disabilities Act protects employed individuals working in companies with more than 15 employees from negative employment actions based on real or perceived mental health conditions, and limits the circumstances in which an employer can ask about mental health conditions at all. In other words, a person cannot be terminated solely for being depressed or suffering from post-traumatic stress disorder, and an employer cannot legally inquire into any mental health condition you may have. Further, the Americans with Disabilities Act requires an employer to provide reasonable accommodations such as flexible schedules or work from home allowances for those suffering from a mental health condition.

The Mental Health Parity Act prevented large group health plans from placing less favorable annual or lifetime limits on mental health services in comparison to medical or surgical benefits. In other words, this legislation required large health plans to provide mental health benefits at similar levels as other health benefits.

This legislation was expanded and updated in 2008 in the Mental Health Parity and Equity Act. While mental health services are still not a required component of health insurance, this legislation does confirm protection if these are covered components of an insurance program. Similar to the Mental Health Parity Act, mental health and addiction services are required to be offered at the same level of coverage as medical and surgical services. Further, mental health and addiction services cannot be subject to a different cost-sharing arrangement, meaning the copays and coinsurance levels will be similar to other insurance benefits.

Patient Protection and Affordable Care Act

The final piece of the legislative puzzle for mental health conditions is the Patient Protection and Affordable Care Act (PPACA), often lovingly referred to as ObamaCare. PPACA considers mental health and substance abuse as one of the 10 essential health benefits that most insurance plans must cover. In combination with the intended effect of lowering health insurance costs for all Americans, PPACA should represent another significant step forward in normalizing the treatment of mental health conditions.

Recovery is Possible

Despite the fact that mental health conditions are much more acceptable to the general public than in 1970, it is still emotionally taxing to come to grips with the idea that you may need professional support to manage your mental health condition. Even if you have accepted that you have a mental health condition, there is a sense of pride that often keeps an individual from reaching out for help.

If you or a loved one in Des Moines is ready for a change, there is support available. We can help you. We can answer your questions. The admission counselors at our toll-free, 24 hour helpline can help you learn more about your mental health condition. They can help you find your way.