How to Maximize Mental Health Coverage

As Congress seeks to reach consensus on mental health reform, critics say deficits in insurance coverage often leave individuals and families struggling to afford therapy and medications to treat psychological issues, or worse: forgoing care altogether.
No overarching remedy exists to alleviate widespread impediments to access, rooted in everything from health plans that don’t cover many mental health providers to higher out-of-pocket costs for some drugs that treat mental health conditions. Still, there are situation-specific strategies that may maximize coverage and make mental health services and medications more affordable.



Do Your Homework Before Enrolling in a Plan

With the next open enrollment period under Obamacare set to begin Nov. 1, it’s a good time to get an early start researching health insurance plans. That's a solid idea whether you're getting a plan through a health insurance exchange or looking at several options an employer offers.
Large employer plans are not required to cover mental health services, but if they do offer mental health benefits, they must be on par or equivalent to benefits for general medical care, says Sita Diehl, director of state policy and advocacy for NAMI. “So the first thing to do if you’re shopping for a plan through your employer is to make sure that mental health benefits are covered. Most are – most plans do cover mental health – but you’ve got to check it out,” Diehl says. Those who work for a company that offers a plan that doesn't cover mental health may choose to purchase insurance outside their company. You may end up spending more of your own money on monthly premiums as a result, however.

Crunch Dollars and Cents Upfront

Take into account plan deductibles – including out-of-network versus in-network for preferred provider organization, or PPO, plans – and out-of-pocket limits, says Nicholas Moriello, a health insurance broker and president of Health Insurance Associates in Newark, Delaware.

Then go a step further in your cost assessment. Plans commonly use a tiered coverage system, in which drugs – including some for mental and behavioral health – falling into higher tiers receive less-robust coverage, resulting in higher out-of-pocket costs for consumers, says Moriello, who is also a member of the national legislative council for the National Association of Health Underwriters, an industry trade group. Check to see not only whether your medications are covered, but to what degree.

Why should teenagers be allowed to sleep in for as long as it suits them?

Dr Paul Kelly, the chap who knows all about teenagers’ circadian rhythms, is still begging the world to let them lie in, and come to school at 11am. He’s tried it at his former school and apparently it worked a treat. Exam results shot up and the general mood was enhanced. Well it would be, wouldn’t it? It is heaven to stay in bed as long as one pleases. We don’t want young persons back toiling up chimneys or in galleys and laundries, but why pander to these rather annoying creatures?

They’re not the only ones who are clapped-out at 8am. I would much prefer to wake up at lunchtime, and Fielding’s circadian rhythms always pressured him to doss until noon, but the world required that we override nature, rise at first light and go to work, along with all the drillion knackered parents, insomniacs and anyone else who stayed up later than was good for them, exerting themselves in all sorts of ways, often in, or glaring at, artificial light, which bedevils their body clocks. Why, out of all of these exhausted millions, should it just be teenagers who are allowed to moulder in bed for as long as it suits them?

Meanwhile, all the rest of us must let the dogs out, milk the cows, open the shops, run the buses, provide the breakfast, keep the world running and teach in the schools that the teenagers can’t be fagged to go to, because the 11-12 years olds are there already (their body-clocks woke them earlier, and even if they didn’t, the parents had to dump them somewhere while they went off to work). In Dr Kelly’s world, they’d be leaving their unsupervised teenagers festering at home. Imagine the anxiety this would cause the parents at work, reducing productivity. If only they too could rise late, work in bright, airy venues, with lovely long tea-breaks and lunch hours, which all researchers know would do them no end of good, but they can’t, because that’s not how the world works. It’s harsh. Which teenagers should perhaps learn at 9am assemblies.

Why walking to improve your health is not quite as straightforward as it seems

Getting people walking has proved a challenge

Although this sounds fairly easy in principle, getting people to do more exercise through walking is something that has been at the heart of public health policy in a major form since the publication ofphysical activity guidelines in 2008. These guidelines advocated at least 2.5 hours a week of moderate intensity physical activity, such as brisk walking. This target is echoed by the UK’s physical activity guidelines and those inAustralia.
The potential benefits in terms of improved public health are clear, if you consider that only 54% of adult men and 46% of adult women in the US meet the physical activity goal. Worse still, 28% or men and 32% of women reported that they had not done any physical activity that lasted more than 10 minutes in the previous week of being asked.

Getting people walking at the right level of intensity is even harder

Getting people to walk the minimum amount of time is a major challenge. The even bigger challenge comes with the part of the advice that is often ignored or simply not known or understood. In order for their to be a health benefit, the pace at which the walking is done needs to be above a certain intensity.
Although not specifically mentioned in the US Surgeon General’s “Step it Up” programme to promote walking, wearables such as those from Jawbone, Fitbit and others, are one way of tracking the number of steps walked in a day. For most users of these devices, the focus is on getting to the magical 10,000 steps a day. This isn’t really the best target to use however as to achieve the intensity guidelines to achieve a health benefit, it is only the steps that were above a certain pace that count.

The problem with the evidence

The problem with a large amount of the research done in the area of health benefits of walking is that it has been done using surveys and self-reporting which is notoriously inaccurate. Very few studies have been conducted using the “randomised controlled trial” approach to this type of scientific investigation using objective measures of activity that even consumer wearables can now provide.

As at least the US Surgeon General has made clear in his call to action, much more research is needed. Not only to make the evidence for the exact nature of the benefits clear, but also to investigate how people can be persuaded to start and stick with a programme of walking to achieve the recommended amounts of exercise. Although walking results in fewer injuries than say, running, it is not completely free of risk and so this is another area that requires more research.

Are painful experiences from your past slowly killing you?

• Many of us had painful experiences as a child or teen, and while it may seem obvious these experiences impact our mental health, we now know that there are some experiences which can also negatively impact our physical health.
  A study (Adverse Childhood Experiences study) that focused on one's home environment, experiences, family members' mental health, divorce and whether or not love and support was felt, proved that these factors do in fact matter in your physical health.
  
  
  
  
  Why should you be interested in this study? Why should you care? These findings are incredibly important on multiple levels. The authors of the study created the ACE Pyramid to explain why these experiences impact our health.
  Childhood experiences lead to social, emotional and cognitive damage. That devestation can lead to the adoption of health risk behaviors and potentially chronic stress from untreated PTSD (Post Traumatic Stress Disorder) or other mental health issues. This can lead to disease, disability and social problems.
  There is an undeniable link between our childhood experiences and our risk for various diseases, disorders and behaviors, and that the higher your ACE score, the higher your risk. The good news is that intervention at any point, whether in childhood or as an adult, can help decrease risk.

• Curious what you or your children's ACE score is?

  You can take this quiz to find out.
  More than half of the participants answered yes to at least one question, according to the study's findings. More than one in five reported three or more ACEs. Those with scores of four or more showed the greatest risk — four to 12 times higher risk than for those who reported just one ACE — for the following behaviors or diseases:
  
  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease (IHD)
  • Liver disease
  • Cancer
  • Intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases (STDs)
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  For adults, getting treatment for traumatic experiences decreases the risk of developing the above issues. And for those who are currently experiencing the impact of past trauma and struggle with any of the issues above, treatment now can have a dramatic, positive impact on how we will manage stress, heal from our physical and emotional issues and potentially change the direction of our lives!
  Treating the underlying traumatic experiences from the past — or increasing the safety and health of kids who experience trauma, leads to increased mental and physical health for individuals, families and our communities. This means the potential for fewer doctor and hospital visits, fewer sick days from work, more productivity and healthier families.

• How can we help kids who are at risk?

  Parents, teachers and medical professionals can use this information to provide support to children who have been exposed to ACEs. These children need adults to intervene, work to decrease their risks by increasing their safety at home and promote healing from the abuse or neglect they have already experienced.
  There are additional resources with further information on the ACE Study and how to use it, along with resources for the prevention of abuse.