The COVID-19 pandemic has helped bring more attention to mental health issues that can be overlooked in public policy debates. Even if the worst of the pandemic recedes, now is the right time to consider improvements in mental health policy, in particular better screening for mental illnesses; real parity between mental and physical health; and providing cognitive behavioral therapy (CBT) for everyone free of charge.
Better mental health screening
Mental health problems usually present themselves early in life, with three quarters of lifelong mental health problems starting at age 24. However, it takes an average of 11 years between the onset of symptoms and the diagnosis. Early detection allows for earlier and more effective treatment. Screening for Depression and Substance Use Disorders has received the necessary approval from the United States Task Force on Preventive Services and must be covered (often without cost sharing) by private insurance plans, Medicare, and most Medicaid coverages, in large part because of the Affordable Care Act provisions. But too often it is not provided. Mental health screening should now be universal in schools and colleges, as well as in all clinical settings, including those serving pregnant women and new mothers.
Real parity between mental and physical health
Additionally, although laws are in place to require insurance plans to cover mental and physical health care on an equal footing, this does not always happen in practice – in part because the legal framework has significant gaps. A good starting point would be the implementation of the recommendations of the Mental Health and Substance Use Disorders Parity Working Group 2016, including leveling the playing field in terms of prior authorization requirements, introducing parity “models” for insurance companies and imposing civil financial penalties for parity violations. All employer plans should also be legally required to cover mental health care.
Free Universal Cognitive Behavioral Therapy (CBT)
When it comes to the provision of mental health treatment, a simple step in the right direction would be to allow universal access to cognitive behavioral therapy (CBT). CBT is “empirical problem-based psychotherapy that teaches patients to detect and modify thought patterns and to change behavior to reduce distress and promote well-being. “It has been proven very efficient and relatively inexpensive. A study in the UK even concluded that the tax benefits of a higher employer and lower disability claims would outweigh the direct tax costs of free universal provision.
The UK has now introduced free access to therapy without referral through its National Health Service. The US military is now providing psychological support to soldiers to promote “mental fitness.” As Brigadier-General Rhonda Cornum, Director of the Comprehensive Soldiers’ Fitness Program, said, “We have to deal with psychological fitness the same way we do with physical performance.” This is true for everyone. Universal coverage would also send a signal that mental health issues of one kind or another are the norm rather than the exception, which can help reduce stigma.
In the US, providing universal access to therapy will be more complicated than in the UK, but it is still possible through improvements such as:
CBT is relatively inexpensive and quite effective. Of course, there are other forms of therapy that are just as effective for certain conditions – Drug Assisted Treatment (MAT) for Substance Abuse Disorders, for example – and these treatments should also be available for free. The argument for CBT in particular has been presented here because of its high efficiency and low cost; but it should simply be seen as an example of the kind of reforms needed to elevate mental health care more broadly.