Synopsis: "Will Parity in Coverage Result in Better Mental Health Care?"
"The stigma of mental illness, which is substantial and persistent, underlies the debate over parity... .Although stigma continues to contribute to the differential treatment of mental health care in insurance and public policy, powerful economic forces also work against parity in insurance coverage."

"Potential costs are one reason insurers treat mental health services differently. All forms of health care are subject to the "moral hazard" — the increase in use and costs that follows the provision of insurance coverage. But the moral-hazard problem is worse for certain types of mental health care than for other health care services.... [U]nder indemnity insurance, providing protection against the financial risks of illness is considerably more costly for mental disorders than for other conditions."

"For reasons related to both moral hazard and adverse selection, under indemnity insurance, coverage for outpatient mental health care has typically required a higher level of cost sharing than has coverage for outpatient medical care (a copayment of 50 percent, as compared with 20 percent for outpatient care) and has had stricter limits (a maximum of 20 outpatient visits and 30 inpatient days per year)."

"[M]anaged-care plans control costs and utilization in a way that is very different from the approach of fee-for-service indemnity insurance. Instead of influencing the demand for services by establishing the out-of-pocket costs for consumers, managed care influences physicians' decision making, intervenes directly by overriding physicians' decisions, or both. Cost sharing and coverage limits have a less important role in managed-care plans than they did in indemnity plans. This is one reason for the reduction in the level of cost sharing for mental health care under private insurance since the 1980s. [Zuvekas SH. Trends in mental health services use and spending, 1987-1996. Health Aff (Millwood) 2001;20:214-224.] Cost sharing is no longer an essential tool for cost control."

"Management of mental health care (both in programs where it is integrated with general medical care and in specialty programs where it is "carved out" from general medical care) substantially reduces spending. [bold added] For example, Pacific Bell implemented a program of managed mental health care in the early 1990s and reduced mental health care expenditures by 13 percent.* [Goldman W, McCulloch J, Sturm R. Costs and use of mental health services before and after managed care. Health Aff (Millwood) 1998;17:40-52.] The health insurance program for state employees in Massachusetts introduced managed mental health care at the same time that mental health benefits were expanded. The net effect was approximately a 25 percent reduction in spending. [Ma CA, McGuire TG. Costs and incentives in a behavioral health carve-out. Health Aff (Millwood) 1998;17:53-69.] Similarly, when the health insurance program for state employees in Ohio implemented parity for mental health coverage provided by managed-care plans participating in the program, there was an overall savings, although there were some increases in spending by individual plans. [Sturm R, Goldman W, McCulloch J. Mental health and substance abuse parity: a case study of Ohio's state employees program. J Mental Health Policy Econ 1998;1(3):129-34.] In states that have enacted parity laws for mental health coverage provided by managed-care plans, spending increases attributable to the legislation have ranged from 0.2 percent to 0.8 percent of total health care premiums. [Harbin H. Parity in mental health treatment. Testimony before the U.S. Senate Health, Education, Labor and Pensions Committee, Washington, D.C., July 11, 2001., Delaney T. Mental health parity. Washington, D.C.: Health Policy Tracking Service, National Conference of State Legislatures, October 2000.] Even with expanded benefits, managed care blunts the potential increase in the use of services."

"In sum, managed care has fundamentally changed the way in which the utilization and costs of mental health care are controlled. Where parity for mental health care has been established within managed-care programs, increases in spending either have been small or have been offset by reductions in spending. Managed care has effectively gutted the argument that mental health parity will increase costs too much." [pp. 1701-1702]

RG Frank, HH Goldman, TG McGuire. Will Parity in Coverage Result in Better Mental Health Care? New Eng J Med. December 6, 2001; 345(23):1701-1704

Addictionology: Web of Addictions In 1995, the creators of this site, Dr. Andrew L. Homer and Dick Dillon, were disturbed to find that it was easier to learn how to make methamphetamines at home than it was to find out about drug addiction recovery methods or treatment centers on the Web. The result: this no-frills, to-the-point site that provides more than 100 links concerning addiction from a number of sources, including government agencies, universities and medical centers. Find in-depth and targeted information on addiction to various drugs, from misused prescription drugs such as Ritalin to illegal ones like cocaine and heroin.

ADDs--Attention Deficit / Hyperactivity Disorder
Born to Explore

American Psychological Association gives a professional slant to this whole topic. For example, look into this site for a discussion about the Anthrax scare. In the Public Section you won't find much in the way of specific disorders, but it is good for is laying out the basics of who needs professional help and how therapy works. Scroll down broad topics, such as women and children. For instance, one excellent section reviews problematic self-esteem and body issues that adolescent girls may face.

Anxiety-Panic Internet Resource or this excellent Canadian piece: Anxiety Disorders (See "Stress Management for Patient and Physician," below.

Behavioral Solutions, LLC, a subsidiary of Nelson Communications Worldwide (NCW) "Health insurance premiums are again rising at double-digit rates. According to the report, 'Health Behavior Change in Managed Care: A Status Report', prepared by The Center for the Advancement of Health and funded by The Robert Wood Johnson Foundation, most HMO medical directors believe health behavior powerfully influences health outcomes. Behavioral health risks are tied to higher ambulatory care and hospitalization costs and account for as much as 70% of all medical care spending."

Dimentia and Alzheimer's Disease, Click Alzwell Caregiver

Eating Disorders Website called Something Fishy

Mental Health Advisor has an instrument that is used in primary care to screen for mental disorders including depression. It is appropriate for use with the post partum patient. (per Geoffrey Grey). 4.5.02

Mental Health, Mental Help Net will link you to a site where you may find out the symptoms, treatment and online resources for everything from anxiety to schizophrenia. This well-designed site lets you pose questions to psychologists, like Dr. Mark Dombeck; link to 1,600 journals, including the Harvard Review of Psychiatry; and search for conferences.

Mental Health, About.com helps to find a therapist and articles on how the drug sertraline provides relief from the disabling emotions that follow a traumatic experience, for instance. Moderated by clinical psychologist Leonard Holmes, this site covers 30 distinct subject areas, such as stress management and personality disorders. You can access data from trusted sources like the National Library of Medicine. The Psych Medications section points out the side effects of certain drugs

Mental Health, Internet

Mental Health Advisor: learn more about and get help with mental health problems including depression, anxiety, and alcohol and drug abuse. All resources are designed for adults. Those for children and adolescents are promised.

Mental Health Matters was founded by Judy Castelli, who admittedly suffers from as much as multiple--44--personalities, clearly a "Personality Disorder." This site is designed to help patients and families suffering with mental disorders. It offers many support services from therapists to legal aid to research findings to online help for caregivers and a hotline. It goes into how to get financial assistance, how to find speakers for your mental health events. The number of links it contains can be overwhelming and the quality varies, however Castelli's sensitivity shows.

National Institute of Mental Health is the sister site to the NIH and it puts psychological terms into plain English. In the Reference section there are links to books: Why Johnny Can't Cooperate: Coping with Attention Deficit Problems, brochures, clinical trials or the latest on autism. How about the cost-effectiveness of Mental Health treatment? See "NIMH-Funded Researchers Show Better Treatment for Depression Is Cost-Effective."

Obsessive Compulsive Foundation

Post-Partum Depression:
· Edinburgh Postnatal Depression Scale (EPDS)
· Postpartum Depression Screening Scale (PDSS) by Beck (Beck is Cheryl Beck not Aaron Beck who is the high guru of Cognitive Therapy and who developed the most used depression screening inventory)
( The Scottish one is free and the American one must be purchased. )
Mental Health Advisor has an instrument that is used in primary care to screen for mental disorders including depression. It is appropriate for use with the post partum patient.

Psych Central

STRESS Disorders See "Stress Management for Patient and Physician" and articles on Anxiety Disorders

Suicide Awareness/Voices of Education

Wellmed See their Personal Health Manager, a complete set of personal health management services that allows you to: * Check your health status * Store personal health records securely * Identify personal health risks * Get accurate, detailed information relevant to your individual needs

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