Pitfalls of Using Health Insurance For Mental Health Care

Because of the unfortunate stigma still attached to mental health conditions, people should think twice before using their health insurance to pay for visits to a mental health professional, such a marriage and family therapist, a psychologist or psychiatrist.

If you do have health insurance coverage, your first reaction might be to think, "Well, if I've got insurance, why shouldn't I use it? That's what it's there for." And, most of the time, that's true. I know I'm certainly grateful for my health insurance when I go to the doctor or dentist.

But it gets more complicated when it comes to mental health care because of negative associations attached to psychological disorders. For example, people probably think differently about an individual who has a physical condition such as a thyroid disorder versus someone who has a psychological condition such as major depression.

The reality is, if you want to get your insurance company to pay for your mental health care, the mental health care provider has to give you a serious psychological diagnosis or the insurance company won't pay for the treatment.

For instance, many insurance companies won't pay for someone seeing a therapist for couples counseling or for "normal bereavement" following a loved one's death. So your mental health care provider needs to find a serious diagnosis that legitimately describes your situation and that will be acceptable to your insurance company. But, once you have that diagnosis, the big issue becomes confidentiality.

Here's how that works. When you're seeing a therapist and paying for it yourself, the information you discuss in session stays in the room for the most part. The therapist doesn't share the information with anyone else, except when they're required to report child abuse or elder abuse or a handful of other situations covered by law or their profession's code of ethics. So the vast majority of the time, the information you share with your therapist stays just between the two of you, and you can feel completely free to share all the deep problems that brought you to the therapist's office in the first place.

However, your sessions won't be so private any more if your insurance company is paying for all or part of your mental health care, because your diagnosis then becomes part of your health record and it's no longer confidential. That could be detrimental to you in the future.

For example, let's say your therapist diagnoses you with major depressive disorder, which is a very common diagnosis. Think about how people view other people who are seriously depressed. They generally have certain expectations of how depressed people behave.

So having that diagnosis in your health record could affect your ability to get a job in the future. It could be an issue in a child custody battle or other legal problems, especially since law enforcement agencies can access your insurance information at any time. A serious mental health diagnosis could cause problems if you tried to obtain other health insurance or life insurance in the future. Those are just a few examples of situations to think about.

The other issue with using insurance benefits for mental health care is that the insurance company might place limitations on the number of sessions you can obtain or require that you get pre-approval from your primary care physician. Some insurance companies are very generous and allow weekly sessions until your problem is resolved, and they don't interfere very much in the therapeutic process. But some companies place a limit on the number of sessions they'll cover in a given year, and that frankly might not be enough to resolve some serious or longstanding problems.

But, to me at least, those pragmatic challenges of trying to get your insurance company to provide adequate mental health coverage pale in comparison to the confidentiality issue I was talking about earlier. Confidentiality really is the Number One thing you should consider when you're deciding whether you want to use your health insurance to cover mental health care.

Renee Haas is a licensed marriage and family therapist and a life coach. She specializes in helping people enhance their relationships, especially doing couples counseling and working with individuals who are having relationship difficulties with a partner, child, parent, boss or other significant people in their lives. She serves therapy clients in California, either in her Moorpark office or via phone or webcam. She works with coaching clients anywhere via phone or web cam.

Suicide Prevention Through Better Mental Health Care

We need to find ways to make life less difficult for people who struggle with mental illness. No one should have to choose between needed medicine and food or shelter.
We all deserve to have our basic needs met with respect and acceptance. Mental illness is not the person's fault any more than cancer or heart disease is. This is hard for most of us to understand.
What we see of mental illness is just the tip of the iceberg.

Many more people suffer silently. We can't see mental illness, it comes to our attention when it is not treated effectively. Sometimes that makes us uncomfortable, and forces us to look at the results of our personal priorities.
Mental health care and suicide prevention should be obvious public health goals. Medicines are getting better and better at keeping depression controlled, but the enjoyment and satisfaction of everyday life is more than just "getting by" emotionally. Suicide means ending your life on purpose. Suicide prevention means making living look better than dying.

Lots of people with depression, and other mental health problems, find new lives with the right mental health care. Others don't have the same opportunities.
Suicide looks like the best or only choice for them. We can't stop all of the hardships of their lives, but suicide prevention has to include making better mental health care more available.

How to help yourself and your loved ones get better mental health care:

Learn the warning signs of depression.

If the depression is mild and not upsetting sleep, appetite, concentration or irritability, look for a licensed counselor, social worker or psychologist.
If there are any of the following,
frequent crying or anger outbursts, or crying for no reason, or loss of temper at little things
unusual irritability, snappiness, impatience, criticism of others
poor concentration, follow through, or are more easily distracted
avoiding family and friends, saying 'no' to most invitations or suggestions
trouble falling asleep, (longer than 20"-30"), staying asleep (should be getting usual sleep or 6-8 hours a night), or sleeping too much ( more than 2 hours longer than usual), or waking up and not getting back to sleep
panic attacks, with physical signs like fast heart beat, shortness of breath, shaking, sweating, dizziness, nausea, chest tightness or chest pain, numbness or tingling in hands or feet
thoughts of death or suicide
new or increased use of alcohol or recreational or prescription drugs
All of the above persons can do counseling, but a person will probably also need someone who can prescribe medication.

Choosing the right Mental Health Professional assures better mental health care for everyone.
Learning more about depression helps you to get better mental health care for yourself and your loved ones. You will pick up on it sooner, and do something about it before it gets disabling.
Thoughts of suicide don't usually come on suddenly, so noticing depression early and getting help can stop a lot of suffering. Spread the word, help stop the epidemic of suicide.

Nine Recommendations to Increase Continuity of Mental Health Care For Schizophrenia Patients

Continuity of therapy is a vital component of quality care for people with serious mental illnesses and must be given more attention by consumers themselves, family members, advocates, providers, administrators, and researchers alike. At the moment, there is an important opportunity to develop a national consensus statement on the principles and practice standards that should form the basis of a continuum of therapy designed to provide realistic assurance that consumers can access vital medications when and where they are needed. Important strides have been made in identifying the specific factors which promote continuity of therapy - it is time to seize this important opportunity as yet another stepping stone to achieving the transformation of America's mental health care system for the benefit of consumers and their families, our communities, and our Nation. A roundtable of mental health experts has developed a set of nine recommendations for enhancing continuity of medication therapy for persons with schizophrenia or serious mental illness, including schizophrenia. They are as follows:

Mental Healthcare Recommendation #1 -

Encourage collaborations between hospitals and community-based organizations. Use fiscal incentives to foster collaborations including the standardization of information and shared electronic health records.

Mental Healthcare Recommendation #2 -

Use a quality improvement approach to enhance continuity of therapy by benchmarking at the organizational level performance and outcomes standards regarding continuity of care.

Mental Healthcare Recommendation #3 -

Ensure all consumers have a level of care management for the transition from inpatient to community. Care management services should be reimbursable by all payers and the disincentives to providing it should be removed.

Mental Healthcare Recommendation #4 -

Hospitals and community providers should focus on the "Pull Model" of transition from inpatient to outpatient care. The Pull Model focuses on involving community-based providers in the transition planning process from the beginning. Provider organizations should focus on staff competency in engagement and strategies and motivational interviewing.

Mental Healthcare Recommendation #5 -

Accreditation standards should be aligned to address and improve continuity of therapy in treating serious mental illness. This may include developing standards to ensure evidence of an active process of care management and transition between levels of care, a quality review of the success of transition plans, and measuring engagement.

Mental Healthcare Recommendation #6 -

Consumers and their families should be educated about the benefits of maintaining their personal health care history. Ensuring that consumers have detailed information about their illnesses and treatment history will help ensure that providers have access to the information they need to provide appropriate care in a timely manner. The options here range from simple paper and pencil logs and medication histories to electronic records on memory sticks.

Mental Healthcare Recommendation #7 -

Consumer-driven recovery planning should include and the appropriate and necessary use of hospitalization. More thoughtful use of inpatient services could lead to a reduction in emergency room use and ultimately to a decrease in the number of hospitalizations.

Mental Healthcare Recommendation #8 -

Parties who collect data about mental health services and performance should share it with appropriate stakeholders in usable and timely ways. Many payers and public entities collect both population and individual specific information about mental health consumers and services. Population-based data should be shared with all stakeholders, including families and consumers to aid in enhancing the system of care.

Mental Healthcare Recommendation #9 -

There should be meaningful involvement of consumers and their advocates in all levels of system delivery and evaluation. Global involvement of consumers and their advocates in the care delivery process is essential. Examples include using peer specialists as part of a treatment team, active involvement in policy and planning, as well as involvement in developing and implementing performance measurement and evaluation.

Applying these Mental Healthcare Recommendations -

While we have learned that maintaining continuity of therapy has a positive impact on consumer outcomes, the barriers and other impediments to ensuring this continuum of care have been long entrenched in mental health and related care systems. An unacceptably high number of people with serious psychiatric issues - including schizophrenia, depression and bipolar disorder - are "falling between the cracks" in the transition between acute inpatient settings and the community causing harm and disruption in their own lives and those of their families and often bringing their recovery process to a halt.

A continuity of therapy initiative is likely to decrease inappropriate use of emergency room services by consumers with schizophrenia or other serious mental illnesses by assuring consistency in the disease management approach used by all community provider organizations. Both of these likely outcomes of continuity of therapy provide cost reductions for the hospital and cost offset for the investments in continuity of therapy initiative and related therapies.