Mental health parity by rule if not in practice

The Obama Administration has issued final rules telling insurers they must treat mental and physical ailments equally, if they offer coverage for mental health and substance abuse.

The rules had been going through a comment period since August.

(Picture from CMR Canada, which quotes the WHO as estimating depression will be the second-leading cause of disability within 10 years, behind only heart disease.)

The rules, which take effect in July, implement a 2008 act named for the late Paul Wellstone and then-Senator Pete Domenici. Parity had also been a goal of former First Lady Tipper Gore, and the subject of a 1996 Act which the new law strengthens.

The rules appear while some states, notably Wisconsin, continue to debate the question. Republicans there call the act a "jobs killer."

Naturally the American Psychiatric Association (APA) was happy about the new rules, while continuing to seek some tweaks.

The rules may create parity in law, but they may not create it in practice, because employees remain fearful of getting treatment.

A Harris survey commissioned by the APA said nearly three workers in four fear getting fired if they seek treatment for alcoholism and drug addiction. Even depression is resisted by 62%, the survey said, even though productivity is routinely lost because of these conditions.

Of course, there may be something more here. Over half of those in the survey said they feared employer sanctions for seeking treatment for heart disease or diabetes.

The health reform bill now stalled in Congress would guarantee coverage for people who need care, eliminating any incentive for employers to sanction workers who seek it.

The great depression in the American workforce, then, will continue.

This post was originally published on Smartplanet.com