With nearly one in four Americans estimated to have a mental illness and only half of them receiving treatment in a given year, access to affordable, quality mental health care remains out of reach for many. Although health insurance is intended to promote access to mental health care, approximately 35 million Americans covered by self-funded group health plans sponsored by private employers may be unaware that their health plans are not subject to federal standards for medical necessity and network adequacy, key terms that determine the availability of coverage and can significantly limit their access to essential treatment. The Employee Retirement and Security Act of 1974 ("ERISA") governing self-funded group health plans does not require them to base their definitions of medical necessity for covered services on generally accepted standards of care. Nor does ERISA require them to follow or disclose network adequacy standards. To the extent network adequacy standards are often undisclosed, if they exist at all, plan participants can be exposed to significant out-of-network financial liabilities when in-network mental health services are unavailable. ERISA's judicial review provisions further disadvantage plan participants by requiring courts to defer to employer benefit interpretations and by severely restricting available relief. To improve access to affordable, high quality mental healthcare for participants in self-funded health plans, the following reforms are crucial: a federal definition of medical necessity, time and distance standards for network adequacy, hold harmless provisions for out-of-network costs due to network inadequacy, and removal of restrictions on judicial review and available remedies.
Background: Historically, U.S. health insurance plans included fewer and more restrictive benefits for mental health (MH) and substance use disorder (SUD) treatment compared to general medical care. The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) mandated that group-based private health plans covering MH/SUD treatment do so in a way no more restrictive than coverage for general medical care. Multiple rounds of rulemaking, including 2024 final rules most recently, have strengthened federal regulation of plans' non-quantitative treatment limits (NQTLs).
Aims of the study: To investigate how SUD treatment rates, perceived unmet needs, and barriers to treatment changed for adults with group-based private insurance following MHPAEA.
Methods: We conducted a secondary analysis of annual, cross-sectional data from the National Survey on Drug Use and Health (2006-2014) with a sample of adults aged 18-64 years meeting criteria for SUD treatment need. We used difference-in-differences models to estimate and compare outcomes between adults with group-based private insurance (GBPI) and multiple comparison groups including those with individual-based private insurance (IBPI) before (2006-2009) and after (2011-2014) MHPAEA implementation.
Results: Among 32,605 survey respondents with SUD (weighted N=16,108,465), 17,065 individuals had GBPI. For this group, adjusted rates of any past-year SUD treatment remained low, and we did not detect a statistically significant change following MHPAEA implementation (6.4% pre-parity vs. 7.0% post-parity; +0.5 percentage points, 95% CI: -1.1 to 2.2, p=0.514). Difference-in-differences analysis showed no significant difference in changes between those with GBPI and those with IBPI (+3.1 percentage points, 95% CI: -3.8 to 10.0, p=0.380). Self-identified unmet SUD treatment need also remained consistently low (3.9% pre-parity vs. 3.9% post-parity; +0.1 percentage points, 95% CI: -1.0 to 1.1, p=0.895). Among GBPI enrollees reporting unmet need, no significant changes were observed in barriers related to cost (14.9% post-MHPAEA), treatment accessibility (22.8%), ambivalence about seeking treatment (66.8%), or stigma (19.1%). Only half of GBPI enrollees knew their insurance covered SUD treatment, with nearly 40% reporting they didn't know.
Discussion: These findings align with other studies of U.S. parity laws, which have found little to no impact on SUD treatment rates despite potential improvements in financial protection. Limitations include reliance on self-reported data, inability to identify specific insurance plans exempt from MHPAEA, and lack of state-level identifiers to account for pre-existing state parity laws.
Implications for health care provision and use: Providers and health systems may consider new strategies to identify SUD treatment needs and improve awareness of i
Background: Suicide continues to be a major problem worldwide. Persons with a lived experience are being actively involved in suicide research and reports suggest that co-production of suicide research with persons with a lived experience significantly improves its quality and appropriateness.
Aims of the study: The aims of this paper are (i) To identify challenges to Australian suicide prevention strategies and interventions and (ii) To offer recommendations to address these challenges.
Methods: This perspective article is a co-production between an experienced mental health researcher and a person with a lived experience of suicidality, who has worked as a suicide prevention worker and has held leadership positions in government and non-government suicide prevention programs.
Results: Challenges to Australian suicide prevention strategies and interventions include: the careless reporting of suicide in the media, the continuing stigma in seeking help, stigma as a barrier to gatekeeper training, the entry point of suicide prevention services and care of those with suicidal ideation/attempt. Recommendations include: that media must consider the responsible reporting of suicide as a duty of care; that the community response to help-seeking for suicide needs to be one of compassion; that gatekeeper training should be expanded to be universally accessible and messaging in suicide prevention training programs must pay attention to its rationale; that services for those with suicide ideation and attempt must commence with providing a safe space and empathetic support by peer workers and that continuing care after suicidal attempt must be informed by the individual's needs and include informal and family carers, as well as other community agencies.
Discussion: Stigma related to suicide continues to be a major barrier to help seeking and suicide prevention training. The approach to suicide prevention and intervention services needs to focus on stigma reduction, responsible reporting by media and a person-centred approach to care. The perspectives identified here are by no means comprehensive but are merely our observations that we believe, need attention.
Implications for health care provision and use: These perspectives have implications for the early identification and assistance of those at risk of suicide in the community as well as for suicide intervention services.
Implications for health policies: These perspectives have implications for policies related to public health education including the expansion of gatekeeper training, journalism and media, as well as national and state suicide prevention strategies.
Implications for further research: Further research might focus on suicide related stigma reduction measures within communities, improved suicide intervention serv
Background: The COVID-19 pandemic triggered widespread lockdown measures, including a sudden and substantial increase in working from home arrangements. While intended to reduce virus transmission, these measures may have had unintended consequences for mental health. Remote work limits in-person interactions and alters work-life boundaries, potentially influencing psychological well-being. However, empirical research on the mental health effects of working from home -especially under involuntary conditions- is still limited.
Aims of the study: This study investigates the impact of working from home on mental health during the first lockdown in Germany. Specifically, it aims to differentiate between selection effects (i.e., individuals who choose working from home based on their circumstances) and causal effects (i.e., the mental health consequences of working from home itself). The goal is to understand whether working from home, when imposed rather than voluntarily chosen, negatively affects mental well-being.
Methods: We use data from the Mannheim Corona Study (MCS), which collected high-frequency panel data from a representative sample of the German population during the first lockdown (March-July 2020). The analysis focuses on employed individuals and excludes those not working. We create a binary working from home indicator and analyze its association with four mental health measures: two indicators of depressive symptoms, one of loneliness, and one of social interaction frequency. Both pooled linear regressions and fixed effects models are employed to estimate associations while accounting for confounders and unobserved heterogeneity.
Results: Descriptive statistics reveal that working from home was more common among individuals with higher income and education, reflecting a socioeconomic selection effect. Pooled regression results show a significant association between working from home and increased loneliness, depressive symptoms, and reduced social interaction. These associations persist even after controlling for sociodemographic characteristics. Fixed effects panel regressions-focusing on within-individual changes-confirm a significant, though smaller, negative effect of working from home on mental health, particularly regarding loneliness and loss of interest. This strengthens the evidence for a causal link between working from home and reduced psychological well-being, independent of pre-existing personal characteristics.
Discussion: The findings suggest that even privileged individuals working from home experienced a decline in mental health, highlighting the psychological costs of reduced social interaction during the lockdown. Limitations include the lack of pre-pandemic mental health data and the inability to distinguish between voluntary and enforced working from home beyond the lockdown context. Also, the relatively
Background: Mental health issues can impact overall health status, personal relationships, workplace productivity, and other outcomes.
Aims of the study: The primary objective of this study is to determine whether recent and lifetime mental health problems are significantly related to respondents' subjective social status (SSS).
Methods: Respondents to Waves IV (2008-2009) and V (2016-2018) of the National Longitudinal Survey of Adolescent to Adult Health (Add Health) provide the data for our research. Our empirical approach estimates Spearman correlation coefficients between self-reported mental health measures and SSS followed by multivariate regression models. The final empirical models estimate fixed-effects regressions to control for potential bias due to time-invariant unobserved heterogeneity. SSS is measured on a scale from 1 to 10, with 10 indicating perceived highest place in society.
Results: All four explanatory mental health measures (ever been diagnosed with depression, ever been diagnosed with PTSD, ever been diagnosed with anxiety or panic disorder, and past 12 month psychological or emotional counseling) are negatively and significantly (p < 0.05) associated with the outcome variable, SSS.
Discussion: Relative placement in society is associated with overall health and well-being. This study contributes in a methodologically meaningful way to the existing literature by employing empirically advanced statistical techniques to panel data. The main findings clearly demonstrate that mental health issues are negatively associated with SSS.
Implications: These findings have important policy implications for mental health counselors, employers, and society in general as mental health problems become more common and less stigmatized in the U.S.
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