Gap In Services, Adult Mental Health

Until about a week ago, I had no idea that private insurance does not cover case management. I was surprised and baffled to make this discovery.  How can it be?  How does having private insurance negate the possible need for case management? Why are there so many systemic barriers for people with mental illness?

Chapter 35 of our text discusses the "plethora of existing barriers" that make finding, accessing, and qualifying for services close to impossible. It mentions that case managers themselves often have to create services and supports for clients because often what the client needs is nonexistent.

I would imagine that Mental Health Parity should cover something like this.  For people with complicated and persistent mental illness, isn't a case manager necessary to assist in navigating the system?  

The goal of parity is that mental health care should be included and equally covered in health insurance policies.  Up until 1996, when President Clinton signed the first Mental Health Parity Act into law, insurers were legally able to give far less coverage for mental health care than for physical conditions.  The benefits that were offered were often much more expensive and had higher co-pays.  Parity was strongly opposed by insurance companies and businesses.  NAMI, the National Alliance on Mental Illness which was founded in 1979, was paramount in getting the bill passed, in part by organizing a protest across from the White House during Clinton's reelection year.  However, the bill was weak and did not offer true parity.  Legislators were unable to pass anything stronger until Democrats regained control of Congress in 2007.  The latest parity act, called The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008, was signed by President Bush on October 3, 2008 as part of  the $700 billion Wall Street bailout bill.  This law made it illegal for group health plans to offer mental health benefits that were unequal to medical coverage.  This meant that co-pays, deductibles, inpatient hospital days, and the number of outpatient visits had to be equal to those offered for physical medical reasons.  It did not mean that mental health care was covered in all insurance policies.  And since health insurance in the U.S. has been, until recently, tied to employment, those who are/were unemployed or work in situations where health care is not a benefit are still lacking mental health care if and when it is needed.

Getting back to case management, it seems like it would be useful for many reasons.  Life threatening and complicated physical illnesses require many providers, medications, and treatments.  Couldn't a case worker be the one person creating a container of and connection to all those involved in care?  

Maybe as a future social worker I am just biased.  The real problem is the system is generally too complicated and disjointed.  If the system of health care, mental and otherwise, were just made more simple...well, then there would be less of a need for social workers!

References:

Ritter, J. A. (2013). Social Work Policy Practice, Changing our Community, Nation, and the World. Boston, MA: Pearson. 

Weil, M. (2013). The handbook of community practice. Washington, DC: SAGE.