The Impact of Health Care Reform on Mental Health Treatment

Congratulations to President Obama and Congress for the historic passage of the health care reform legislation, the Patient Protection and Affordable Care Act (H.R. 3590), along with the Health Care and Education Affordability Reconciliation Act of 2010 (HR 4872) which makes improvements to the Senate bill. The reforms should provide quality, affordable health care to nearly all Americans for the first time in our nation's history.

So what does this mean for mental health care? As a Clinical Psychologist in private practice for the past 3 years, I have seen many patients struggle to afford the psychological treatment they needed for their mental health. When I first began my practice in 2007, essentially all of my patients were paying for therapy out of pocket, or without the help of their insurance benefits. In the Bay Area, the average cost is $150 per therapy hour, with some therapists allowing a sliding scale fee for therapy. My patients’ average length of treatment is approximately 4 months of weekly therapy, with some coming in for brief, specific types of treatment, and others choosing to engage in long term treatment for 2 years or more. While many of these patients have health insurance, their insurance benefits frequently do not cover their psychotherapy because their mental health diagnosis is not considered parity. (see What The California Mental Health Parity Law Means: AB 88.) Further, in the face of many job loses and the rapid decline of the American economy in recent times, many patients found themselves no longer able to afford to pay for psychotherapy out of pocket.

"These reforms will allow Americans to achieve full health and recovery through significant investments in expanded health care access, including mental health, substance use, rehabilitation and prevention services, as well as collaborative care and chronic care management," said Laurel Stine, director of federal relations at the - The Bazelon Center for Mental Health Law. "This is particularly notable given that four of the ten leading causes of disability in the United States are mental disorders and 87 percent of Americans cite lack of insurance coverage as the top reason for not seeking mental health services," Stine added.

"Furthermore, these reforms are truly significant triumphs in the integration of mental health in health care," said Stine. "Building upon the recent congressional victory of mental health parity in 2008, millions of Americans will have parity benefits and the guarantee of mental health coverage and will not live in fear of being denied coverage due to a pre-existing condition, such as a mental disorder."

Only time will tell to what extent the health care reform will significantly influence the management of mental health problems in the United States. However, this appears to be a step in the right direction in addressing the dilemma of untreated mental illness in this country.

This article was composed by Christina Villarreal, Ph.D., Clinical Psychologist in Oakland, CA