Mental Health and Mental Illness: Mental Health Benefits Legislation

A number of state and federal initiatives have aimed to address this issue by increasing parity for mental health coverage.

• At the state level, forty-nine states and the District of Columbia (Cauchi et al., 2011) have enacted some type of mandate legislation.
• At the federal level, the 1996 Mental Health Parity Act (Solis, 2012), the 2008 Mental Health Parity and Addiction Equity Act (Employee Benefits Security Administration, 2010), and the Affordable Care Act (Patient Protection and Affordable Care Act, 2010) have led to progressively stronger parity requirements.

Current provisions of the 2010 ACA require state Medicaid programs and insurance plans in state health insurance exchanges to cover both mental health and substance abuse as one of ten categories of essential health benefits.

• Access to care: median increase of 13.6 percentage points (8 data points reported in 3 studies)
• Financial protection: median decrease in out-of-pocket spending per user of 4.6 percentage points (7 data points reported in 2 studies)
• Appropriate utilization of mental health services: in general, studies reported that mental health benefits legislation increased the following:
  • Visits to mental health specialists (3 data points reported in 3 studies)
  • Receipt of recommended medication, therapy, or treatment duration modeled on evidence-based findings or standard guidelines (6 data points reported in 2 studies)
  • Mental health visits for persons who need mental health care (5 data points reported in 5 studies)
• Morbidity: the percentage of those in poor mental health decreased, as measured by the Mental Health Inventory Scale (poor mental health = MHI-5 score <67; 1 study)
  • In states that passed parity laws during the study period, there was a decrease of 3.2 percentage points in the proportion of people with poor mental health.
  • In states with parity laws, a smaller proportion of people had poor mental health compared to people in states without parity laws (2.8 percentage points difference).
• Mortality: benefits legislation was associated with decreased suicide rates (2 studies)

Results were generally more favorable for comprehensive parity legislation than limited parity legislation (10 data points reported in 6 studies).

Change in cost to insurance plans was measured as a percentage of insurance premiums per person. Of the 11 studies that assessed the impact on plan costs, four were for the Federal Employee Health Benefits (FEHB) program, two were studies of state mandates, and five assessed plans of individual large employers.

• One of the plans assessed in three of the FEHB studies showed benefits legislation led to a 0.23% increase in annual premiums.
• In Oregon, all of the assessed plans had slight increases in their annual premiums; the highest was 0.60%. In Vermont, annual premiums for mental health and substance abuse decreased.
• Two of the large employers reported premium increases of 0.29% and 1.04%.

In summary, expanding mental health benefits has not lead to substantial cost increases for health insurance plans, measured as a percentage of premiums. Evidence of other economic effects, such as business and employment-related outcomes was limited.

• There is limited research investigating the effects of mental health benefits legislation on mental health outcomes. Specifically, more studies are needed to assess effects on morbidity (reduction of symptoms, relapse prevention, remission, and recovery), mortality, and quality of life
• Further research is needed to clarify the role of mental health benefits legislation in reducing health-related disparities and improving mental health outcomes among important population subgroups (e.g., low socioeconomic status [SES] groups, racial and ethnic minorities, and individuals diagnosed with different types of mental illness).
• There is limited evidence for those covered by public health insurance (e.g., Medicaid and Medicare). Further research is needed in these populations to confirm the effectiveness of mental health benefits legislation in improving mental health.
• Evaluations of the effects of the 2008 federal legislation, the Mental Health Parity and Addiction Parity Act, are needed as this law contains more requirements for parity than the earlier 1996 Mental Health Parity Act.
• Evaluations of long-term (more than three years) effects of mental health benefits legislation are needed.
• Researchers reported a utilization outcome that often combined measures of inpatient and outpatient utilization. The desired direction for these types of utilization differs with various patient conditions; reporting them separately will better indicate that patients are receiving appropriate care. Another challenge in mental health is the determination of whether care provided is evidence-based or guideline-concordant. In addition, most studies reporting any utilization lacked measures of appropriateness of use, such as descriptions of provider type and patient need for mental health care.

• All of the included studies were conducted in the U.S.
• Twenty-eight studies examined effects of state or federal mental health/substance abuse parity policies or legislation, and two examined effects of state-mandated coverage.
• Six studies examined effects of comprehensive parity legislation or policies.
• Most studies were conducted between 1990 and 2011 and used a nation-wide sample to examine effects of federal legislation or state mandates.

Sipe TA, Finnie RKC, Knopf JA, et al. Effects of mental health benefits legislation: a Community Guide systematic review. American Journal of Preventive Medicine. 2015;48(6):755-66.

Jacob V, Qu S, Chattopadhyay S, et al. Legislations and policies to expand mental health and substance abuse benefits in health insurance plans: a Community Guide systematic economic review. Journal of Mental Health Policy and Economics. 2015;18(1):39-48.

Community Preventive Services Task Force. Recommendation for mental health benefits legislation. American Journal of Preventive Medicine. 2015;48(6):767-70.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table – Effectiveness Review

Economic Review

Summary Evidence Table – Economic Review

Effectiveness Review

An R, Sturm R. Self-reported unmet need for mental health care after California’s Parity Legislation. Psychiatric Services 2010;61(9):861-2.

Azrin ST, Huskamp HA, Azzone V, Goldman HH, Frank RG, Burnam MA, Normand S-LT , Ridgely MS, Young AS, Barry CL, Busch AB, Moran G. Impact of full mental health and substance abuse parity for children in the Federal Employees Health Benefits Program. Pediatrics 2007;119(2):e452-9.

Azzone V, Frank RG, Normand SLT, Burnam MA. Effect of insurance parity on substance abuse treatment. Psychiatric Services 2011;62(2):129-34.

Bao Y, Sturm R. The effects of state mental health parity legislation on perceived quality of insurance coverage, perceived access to care, and use of mental health specialty care.Health Serv Res 2004;39(5):1361-77.

Barry CL, Busch SH. Caring for children with mental disorders: do state parity laws increase access to treatment? J Ment Health Policy Econ 2008;11(2):57-66.

Barry CL, Busch SH. Do state parity laws reduce the financial burden on families of children with mental health care needs? Health Serv Res 2007;42(3 Pt 1):1061-84.

Barry CL, Gabel JR, Frank RG, Hawkins S, Whitmore HH, Pickreign JD. Marketwatch – Design of mental health benefits: Still unequal after all these years. Health Aff 2003; 22(5):127-37.

Barry CL. The political economy of mental health parity. Diss. Harvard University, Cambridge: 2005.

Branstrom RB, Sturm R. An early case study of the effects of California’s mental health parity legislation. Psychiatric Services 2002;53(10):1215-6.

Branstrom RB, Cuffel B. Economic grand rounds: policy implications of adverse selection in a preferred-provider organization carve-out after parity. Psychiatric Services 2004;55(4):357-9.

Burnam MA, Buntin MB, Dausey D, Ridgely MS, Teleki S, Young A, et al. Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final report. Washington (DC): US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; 2004. Available at URL: http://aspe.hhs.gov/daltcp/reports/parity.htm.

Busch AB, Huskamp HA, Normand S-LT, Young AS, Goldman H, Frank RG. The impact of parity on major depression treatment quality in the Federal Employees’ Health Benefits Program after parity implementation. Med Care 2006;44(6):506-12.

Busch SH, Barry CL. New evidence on the effects of state mental health mandates. Inquiry 2008;45(3):308-22.

Ciemins EL. The effect of mental health parity on children’s mental health and substance abuse service utilization in Massachusetts. University of California, Berkley, Fall 2003; 118 pages.

Dave DP, Mukerjee SP. Mental health parity legislation, cost-sharing and substance-abuse treatment admissions. Health Econ 2009;20(2):161-83.

Dinallo E. Report by the Superintendent of Insurance on the cost and effectiveness of New York’s 2006 mental health parity legislation (Timothy’s Law). New York State Insurance Department May 2009; 21 pages.

Goldman HH, Frank RG, Burnam MA, Huskamp HA, Ridgely MS, Normand S-LT, Young AS, Barry C L, Azzone V, Busch AB, Azrin ST, Moran G, Lichtenstein C, Blasinsky M. Behavioral health insurance parity for federal employees. New Engl J Med 2006;354(13):1378-86.

Harris KM, Carpenter C, Bao Y. The effects of state parity laws on the use of mental health care. Med Care 2006;44(6):499-505.

Jensen G, Rost K, Burton R, Bulycheva M. Mental health insurance in the 1990s: Are employers offering less to more? Health Aff 1998;17(3):201-8.

Klick J, Markowitz S. Are mental health insurance mandates effective? Evidence from suicides.Health Econ 2005;15(1):83-97.

Lang M, The impact of mental health insurance laws on state suicide rates. Health Economics Article first published online: 19 DEC 2011.

McConnell J, Gast S, Ridgely S, Wallace N, Jacuzzi N, Rieckmann T, McFarland B, McCarty D. Behavioral health insurance parity: Does Oregon’s experience presage the national experience with the Mental Health Parity and Addiction Equity Act? Am J Psychiat 2011;8 pages.

McGuire TG, Montgomery JT. Mandated mental health benefits in private health insurance. J Health Polit Policy Law 1982;7(2):380-406.

Morrisey MA, Jensen GA. Employer-sponsored insurance coverage for alcoholism and drug-abuse treatments. J Stud Alcohol 1988;49(5):456-61.

Morton JD, Aleman P. Trends in employer-provided mental health and substance abuse benefits. Monthly Lab Rev 2005;128(4):25-35.

Pacula RL, Sturm R. Mental health parity legislation: much ado about nothing? Health Serv Res 2000;35(1 Pt 2):263-75.

Rosenbach M, Ammering CJ. Trends in Medicare Part B mental health utilization and expenditures: 1987-92. Health Care Financ Rev 1997;18(3):19-42.

Rosenbach M, Lake T, Young C, et al. Effects of the Vermont mental health and substance abuse parity law. DHHS Pub. No. (SMA) 03-3822, Rockville (MD): Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; 2003.

Sturm R, Goldman W, McCulloch J. Mental health and substance abuse parity: a case study of Ohio’s state employee program. J Ment Health Policy Econ 1998;1(3):129-34.

Sturm R, Pacula RL. State mental health parity laws: cause or consequence of differences in use? Health Aff 1999;18(5):182-92.

Sturm R. State parity legislation and changes in health insurance and perceived access to care among individuals with mental illness: 1996-1998. J Ment Health Policy Econ 2000;3(4):209-13.

Teich JL, Buck JA. Mental health benefits in employer-sponsored health plans, 1997-2003. J Beh Health Serv Res 2007;34(3):343-8.

Trivedi AN, Swaminathan S, Mor V. Insurance parity and the use of outpatient mental health care following a psychiatric hospitalization. JAMA 2008;300(24):2879-85.

Zuvekas SH, Regier DA, Rae DS, Rupp A, Narrow WE. The impacts of mental health parity and managed care in one large employer group. Health Aff 2002;21(3):148.

Zuvekas SH, Rupp AE, Norquist GS. Spillover effects of benefit expansions and carve-outs on psychotropic medication use and costs. Inquiry 2005a;42(1):86-97.

Zuvekas SH, Rupp AE, Norquist GS. The impacts of mental health parity and managed care in one large employer group: A reexamination – An update of a 2002 study revises the authors.Health Aff 2005b;24(6):1668-71.

Zuvekas SH, Meyerhoefer CD. Coverage for mental health treatment: do the gaps still persist? J Ment Health Policy Econ 2006;9(3):155-63.

Economic Review

Azrin ST, Huskamp HA, Azzone V, et al. Impact of full mental health and substance abuse parity for children in the Federal Employees Health Benefits program.Pediatrics 2007;119(2):e452.

Azzone V, Frank RG, Normand SLT, Udrey Burnam M. Effect of insurance parity on substance abuse treatment.Psychiatr Serv 2011;62(2):129-34.

Goldman HH, Frank RG, Burnam MA, et al. Behavioral health insurance parity for federal employees. N Engl J Med 2006;354(13):1378-86.

Hustead EC, Sharfstein SS. Utilization and cost of mental illness coverage in the Federal Employees Health Benefits Program, 1973. Am J Psychiatry 1978;135(3):315-9.

McConnell KJ, Gast SH, Ridgely MS, et al. Behavioral health insurance parity: Does Oregon’s experience presage the national experience with the Mental Health Parity and Addiction Equity Act? Am J Psychiatry 2012;169(1):31-8.

Rosenbach M, Lake T, Young C, et al. Effects of the Vermont mental health and substance abuse parity law. DHHS Pub. No. (SMA) 03-3822. Rockville (MD): Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; 2003.

Cseh A. Labor market consequences of state mental health parity mandates. Forum for Health Economics & Policy, Vol 11. Available at URL: http://ideas.repec.org/a/bpj/fhecpo/v11y2008i2n5.html.

Lang M. The impact of mental health insurance laws on state suicide rates. Health Econ 2013(2011);22(1):73-88.

Mathur A. Health insurance and job creation by the self-employed. Small Business Econ 2010;35(3):299-317.

Cuffel BJ, Goldman W, Schlesinger H. Does managing behavioral health care services increase the cost of providing medical care? J Behav Health Services Res 1999;26(4):372.

Grazier KL, Pollack H. Translating behavioral health services research into benefits policy. Med Care Res Rev 2000;57(2S):53-71.

Sasso AT, Lurie IZ, Lee JU, Lindrooth RC. The effects of expanded mental health benefits on treatment costs. J Ment Health Policy Econ 2006;9(1):25-33.

Sturm R, Goldman W, McCulloch J. Mental health and substance abuse parity: A case study of Ohio’s state employee program. J Ment Health Policy Econ 1998;1(3):129-34.

Zuvekas SH, Regier DA, Rae DS, Rupp A, Narrow WE. The impacts of mental health parity and managed care in one large employer group. Health Affairs 2002;21(3):148-59.

Zuvekas SH, Rupp AE, Norquist GS. Spillover effects of benefit expansions and carve-outs on psychotropic medication use and costs. Inquiry 2005;42(1):86-97.

Zuvekas SH, Rupp AE, Norquist GS. The impacts of mental health parity and managed care in one large employer group: a reexamination. Health Affairs 2005;24(6):1668-71.

As a point of reference,

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, signed into law on October 3rd, 2008, requires group health insurance plans (those with more than 50 insured employees) that offer coverage for mental health and substance use disorders to provide those benefits in no more restrictive way than all other medical and surgical procedures covered by the plan (Substance Abuse and Mental Health Services Administration).

Eighteen bibliographic databases were searched between October 2010 and January 2011, using the search terms listed below. All years of publications available in the databases were searched. The databases searched covered publications in medical and social sciences, behavioral sciences, business and management, legal, legislative, and grey literature. The types of documents retrieved by the search included journal articles, books, book chapters, reports, handbooks, economics evaluations, dissertations, theses, technical reports, government reports, and conference papers.

Search terms and search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software. Once the literature search was completed, Community Guide staff reviewed the citations using the following inclusion and exclusion criteria to narrow down the publications to be reviewed.

Studies were considered for inclusion if they:

1. Evaluated an intervention relating to mental health benefits legislation, including executive orders mandating coverage for mental disorder or substance abuse services at the federal or state level
2. Measured and reported at least one review outcome (i.e., access to care, financial protection, utilization, quality of care, diagnosis of mental illness, morbidity, mortality, or quality of life); and
3. Were reported in English

Studies were excluded if they:

1. Were based primarily on simulation data
2. Considered reforms to restructure care only, such as Medicaid waivers
3. Evaluated single disease mandates, such as a mandate for coverage of autism only; or
4. Were conducted outside the U.S., because of differences in health systems and types of legislation

Search Terms

Parity Terminology

• access to health service(s)
• accessibility of health service(s)
• carveout(s)
• carve-out(s)
• coinsurance
• co-insurance
• community health center(s)
• community mental health center(s)
• community mental health service(s)
• community services
• comprehensive health care
• deductible(s)
• delivery of health care
• delivery of health care, integrated
• employee benefit(s)
• employee health insurance
• employee retirement income security act
• employer retirement income security act
• equality
• federal parity legislation
• health benefit(s) plan(s,ning)
• health care delivery
• health care disparities
• health care disparity
• health care policy
• health care policies
• health care reform
• health care utilization
• health expenditures
• health equity
• health insurance
• health policy (ies)
• health services access
• health services accessibility
• healthcare disparity(ies)
• insurance
• insurance benefits
• insurance coverage
• insurance, health
• insurance, psychiatric
• integrated service(s)
• interdisciplinary treatment approach(es)
• jurisprudence
• legislation
• legislation as topic
• legislative process(es)
• managed care
• managed care program(s)
• mandate(s) (ed)
• medically uninsured
• medically underinsured
• mental health parity
• mental health parity legislation
• outpatient services
• outpatient treatment(s)
• parity
• parity law
• parity legislation
• policy (ies)
• psychiatric insurance
• regulation(s)
• speciality visit(s)
• state parity legislation
• substance abuse parity
• substance abuse parity legislation
• underinsured health insurance
• uninsured health insurance
• universal coverage
• utilization

Mental Health Terminology

• addict(s)
• addiction(s)
• addictive behavior(s)
• affective disorders
• alcohol abuse
• alcohol dependence
• alcohol drinking
• alcohol drinking patterns
• alcoholism
• anxiety
• behavior, addictive
• depression
• depression emotion
• depressive disorder, major
• drug abuse
• drug dependence
• drug dependency
• dysthymia
• dysthymic disorder
• intravenous drug usage
• intravenous drug user(s)
• intravenous substance abuse(er(s)
• major depression
• mental disorder(s)
• mental health
• mental health services
• mental illness(es)
• minor depression
• mood disorder(s)
• posttraumatic stress disorder
• stress disorder(s), post-traumatic
• substance abuse
• substance abuse, intravenous
• substance dependence
• substance related disorder

Databases Searched all years available searched

• Medline (OVID) searched 10/8/2010 results 9,839 (see search strategy below)- bibliographic citations and author abstracts from more than 5,500 biomedicine and life sciences journals.
• ABI/INFORM (ProQuest) searched 1/25/2011 results 247 (see search strategy below) – over 1,850 journals covering a variety of business-related subject areas including financial, pharmaceuticals, manufacturing, and more.
• CABI – Global Health (CAB Direct) searched 1/24/2011 results 10 – (see search strategy below)- includes references to journals, books, conferences, reports and handbooks.
• CINAHL (EBSCOHOST) searched 1/23/2011 results 813 (see search strategy below) – provides indexing for more than 3,000 journals from the fields of nursing and allied health. The database contains more than 2.3 million records dating back to 1981.
• Cochrane (The Cochrane Library) – searched 1/21/2011 results 319 (see search strategy below) The Cochrane Library is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about groups in The Cochrane Collaboration. Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database.
• Embase (OVID) – searched 10/8/2010 results 11,013 (see search strategy below)- indexing over 3,500 international journals in the following fields: drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic medicine, and biomedical engineering/instrumentation. There is selective coverage for nursing, dentistry, veterinary medicine, psychology, and alternative medicine.
• ERIC (CSA) – searched 1/14/2011 results 49 (see search strategy below) – The ERIC (Education Resources Information Center) database is sponsored by the U.S. Department of Education to provide extensive access to educational-related literature. ERIC provides ready access to education literature to augment American education by increasing and facilitating the use of educational research and information to improve practice in learning, teaching, educational decision-making, and research. ERIC provides coverage of journal articles, conferences, meetings, government documents, theses, dissertations, reports, audiovisual media, bibliographies, directories, books and monographs.
• Google Scholar (http://www.google.com) searched 1/25/2011 results ~27,500 Search of +parity +mental +insurance yielded approx. 27, 500 hits – attached file shows first 60 only. Most of the journals in Google Scholar are covered in other databases that can be searched more precisely.
• Lexis/Nexis (http://www.lexis.com) searched 1/28/2011 results 496 (see search strategy below)- current United States statutes and laws and a large volume of published case opinions dating from the 1770s to the present, as well as publicly available unpublished case opinions from 1980 on. In 2000, Lexis began building a library of briefs and motions.
• LILACS -Literature in the Health Sciences in Latin America and the Caribbean (http://lilacs.bvsalud.org/en/) searched 1/24/2011 results 4 (see search strategy below) LILACS is the most important and comprehensive index of scientific and technical literature of Latin America and the Caribbean. For 25 years contributing to increase visibility, access and quality of health information in the Region. LILACS in numbers: 27 countries, 836 journals, 570,965 records, 460,945 articles 76,545 monographs 27,274 thesis 192,399 full texts.
• National Council on State Legislatures searched “mental insurance parity” on 1/29/2011 results 39 (see search strategy below) – Provides information about state governing bodies, current legislation and reports, surveys, and policies
• National Research Register – searched 1/30/2011 results 0 (zero) (see search strategy below) The National Research Register (NRR) was created to provide a public, searchable listing of health research activity in the UK funded by, or of interest to, the National Health Service. It covers years 2000 2007 only. Its original aims included identifying unpublished research – particularly important to those undertaking systematic reviews, providing early warning on research which may lead to important findings, helping to improve the uptake and participation in clinical trials, identifying and bringing together researchers between and across related areas of research, helping to avoid unnecessary duplication in research.
• NTIS – National Technical Information Service (http://www.ntis.gov/) searched 1/25/2011 results 18 (see search strategy below) is the preeminent resource for accessing the most recent research sponsored by the United States and select foreign governments. Coverage for NTIS dates back to 1900 and contains over 2 million descriptive summaries regarding papers and titles NTIS has received from the government. Over 60,000 records are added annually.
• PsycINFO (OVID) – searched 1/19/2011 results 3207 (see search strategy below)- abstract database that provides systematic coverage of the psychological literature from the 1800s to the present. Contains citations and summaries of peer-reviewed journal articles, book chapters, books, dissertations, and technical reports, all in the field of psychology and the psychological aspects of related disciplines, such as medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, anthropology, business, and law. Journal coverage, spanning 1806 to present, includes international material selected from more than 2,450 periodicals from more than 49 countries written in 29 languages. Current chapter and book coverage includes worldwide English-language material published from 1987 to present.
• PubMed (http://www.pubmed.gov) parity and mental in title searchstrategy: mental[Title] AND parity[Title] limit to English language. Searched on 1/19/2011 results 141 – -comprises more than 21 millions citations from Medline, life sciences journals, biomedical literature, and online books- a 21 million citations for biomedical literature from MEDLINE, life science journals, online books.
• SIGLE System for Information on Grey Literature in Europe (http://www.opengrey.eu/) searched 1/30/2011 results 0 (zero) (see search strategy below) – Examples of grey literature include: technical or research reports, doctoral dissertations, some conference papers and pre-prints, some official publications, discussion and policy papers.
• Sociological Abs searched 1/14/2011 results 136 (see search strategy below)- abstracts and indexes the international literature in sociology and related disciplines in the social and behavioral sciences. The database provides abstracts of journal articles and citations to book reviews drawn from over 1,800+ serials publications, and also provides abstracts of books, book chapters, dissertations, and conference papers.
• Web of Science searched 1/23/2011 results 340 (see search strategy below)- world’s leading scholarly literature in the sciences, social sciences, arts, and humanities and examine proceedings of international conferences, symposia, seminars, colloquia, workshops, and conventions.
• Number of studies identified by expert search – 6

Search Strategies

Medline (OVID) searched 10/8/2010 results 9839

1. exp mental health services/ec,lj,sn,sd,td,ut
2. *mental health services/ ec,lj,sn,sd,td,ut
3. exp mental disorders/co,di,ec,ep,lj,pc,sn,th
4. *mental disorders/ co,di,ec,ep,lj,pc,sn,th
5. mental illness.mp.
6. *depression/
7. *depressive disorders
8. *depressive disorder, major/
9. *dysthymic disorder/
10. *mood disorders/
11. *anxiety/
12. stress disorders, post-traumatic/
13. or/1-12
14. alcohol abuse.mp.
15. drug abuse.mp.
16. substance abuse.mp.
17. drug abuse.mp.
18. exp alcohol drinking/
19. *alcohol drinking/
20. exp substance-related disorders/
21. *substance-related disorders/
22. exp behavior, addictive/
23. *behavior, addictive/
24. addiction$.mp.
25. *addict.mp.
26. exp substance abuse, intravenous/
27. *substance abuse, intravenous/
28. alcohol dependence.mp.
29. drug dependence.mp.
30. substance dependence.mp.
31. or/14-30
32. 13 or 31
33. exp insurance coverage/
34. exp insurance, psychiatric/
35. *insurance, psychiatric/
36. exp insurance, health/
37. *insurance, health/
38. exp health benefit plans, employee/
39. *health benefit plans, employee/
40. exp health expenditures/
41. *health expenditures/
42. exp comprehensive health care/
43. *comprehensive health care/
44. exp universal coverage/
45. *universal coverage/
46. exp managed care programs/
47. *managed care programs/
48. exp insurance benefits/
49. *insurance benefits/
50. exp medically uninsured/
51. *medically uninsured
52. exp “deductibles and coinsurance”/
53. “deductibles and coinsurance”/
54. carve-outs.mp.
55. carve-outs.ti,ab.
56. carveout.mp.
57. carveout.ti,ab.
58. carve-out.mp.
59. carve-out.ti,ab.
60. or/33-59
61. exp health services accessibility/
62. *health services accessibility/
63. exp “delivery of health care”/
64. *delivery of health care/
65. exp delivery of health care, integrated/
66. *delivery of health care, integrated/
67. exp community mental health services/
68. *community mental health services/
69. exp community health centers/
70. *community health centers/
71. outpatient services.mp.
72. utilization.mp.
73. specialty visit*.mp.
74. or/61-73
75. exp legislation as topic/
76. exp jurisprudence/
77. *jurisprudence/
78. mental health parity.mp.
79. mental health parity.ti.
80. mental health parity legislation.mp.
81. mental health parity legislation.ti.
82. substance abuse parity.mp.
83. substance abuse parity.ti.
84. substance abuse parity legislation.mp.
85. substance abuse parity legislation.ti.
86. parity.mp.
87. parity legislation.mp.
88. parity law$.mp.
89. (mandate or mandates or mandated).mp.
90. regulation$.mp.
91. equality.mp.
92. (policy or policies).mp.
93. exp health policy/
94. *health policy/
95. exp healthcare disparities/
96. *healthcare disparities/
97. exp health care reform/
98. *health care reform/
99. exp employee retirement income security act/
100. *employer retirement income security act/
101. or/75-100
102. 32 and 60 and 101
103. 32 and 74 and 101
104. 102 or 103
105. limit 104 to (English language and humans)

ABI/INFORM search strategy searched 1/25/2011 results 247

(“mental illness” or depression or anxiety or “mental health services” or “mental disorders” or “dysthymic disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “drug abuse” or “substance related disorders” or “addictive behavior” OR “addictive behaviors” or “addiction” ) AND (parity or mandate or mandated or mandates) AND (insurance or uninsured or medicare or medicaid)
Database: ABI/INFORM Research
Look for terms in: Citation and abstract
Publication type: All publication types

CABI search strategy 1/24/2011 results 10

(Mental illness OR depression OR anxiety OR mental health services OR mental disorders OR dysthymic disorders OR post traumatic stress OR substance abuse OR alcohol abuse OR drug abuse OR drug addiction OR substance related disorders OR addictive behavior OR addictive behaviors OR addiction OR drug addiction OR addict OR addicts OR intravenous substance abuse OR intravenous drug use OR intravenous drug abuse OR drug addiction OR drug dependence)

AND

(legislation OR statutes OR jurisprudence OR mental health parity OR mental health parity legislation OR substance abuse parity legislation OR substance abuse parity OR parity OR parity legislation OR parity law OR parity laws OR mandate or mandates OR mandate OR mandates OR mandated OR regulation OR government regulation OR equality OR health care services policy OR health policy OR employee retirement income security act OR health care reform OR healthcare disparities OR health care disparities)

AND

(health insurance OR insurance coverage OR psychiatric insurance OR benefits OR health expenditures OR comprehensive health care OR universal coverage OR managed care services OR health maintenance organizations OR managed care programs OR insurance benefits OR medically uninsured OR deductible OR deductibles OR coinsurance OR carve-out OR carve-outs OR carveout OR carveouts OR health services accessibility OR access to health services OR health services access OR health care delivery OR delivery of health care OR integrated health care delivery OR integrated delivery of health care OR delivery of integrated health care OR community mental health centers OR community mental health services OR outpatient services OR utilization OR health care utilization OR social services utilization OR specialty visit OR specialty visits)

CINAHL search strategy Searched 1/23/2011 results 813

S1 (MH “Employee Retirement Income Security Act”)

S2 (MH “Health Care Reform”)

S3 “health care disparity”

S4 “healthcare disparity”

S5 “healthcare disparities”

S6 “health care disparities”

S7 health care disparities

S8 health care disparities

S9 policy or policies

S10 (MH “Health Policy”) OR (MH “Public Policy”) OR (MH “Policy Making”) OR (MH “Policy Studies”) OR (MH “Health Policy Studies”)

S11 “equality”

S12 regulation or regulations

S13 (MH “Rules and Regulations”) OR (MH “Government Regulations”)

S14 mandate or mandated or mandates

S15 parity laws

S16 parity law

S17 parity legislation

S18 parity

S19 substance abuse parity legislation

S20 “substance abuse parity”

S21 “mental health parity legislation”

S22 mental health parity

S23 (MH “Jurisprudence”)

S24 (MH “Legislation+”)

S25 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24

S26 “specialty visit”

S27 “specialty visits”

S28 “specialty visits”

S29 “specialty visit”

S30 utilization

S31 (MH “Health Resource Utilization”) OR (MH “Resource Utilization Group”) OR (MH “Utilization Review”)

S32 outpatient services

S33 (MH “Outpatient Service”)

S34 (MH “Community Health Centers”)

S35 (MH “Community Mental Health Services+”)

S36 (MH “Health Care Delivery, Integrated”) OR (MH “Health Care Delivery+”)

S37 (MH “Health Services Accessibility+”)

S38 S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35 OR S36 OR S37

S39 carve-out or carve-outs or carveout or carveouts

S40 deductible

S41 “coinsurance”

S42 “deductibles”

S43 (MH “Medically Uninsured”)

S44 (MH “Insurance Benefits”)

S45 (MH “Managed Care Programs+”)

S46 “universal coverage”

S47 “comprehensive health care”

S48 “health expenditures”

S49 “health expenditures”

S50 “employee health benefits”

S51 “employee health benefit”

S52 (MH “Insurance, Health+”)

S53 psychiatric insurance

S54 (MM “Insurance Coverage”)

S55 S39 OR S40 OR S41 OR S42 OR S43 OR S44 OR S45 OR S46 OR S47 OR S48 OR S49 OR S50 OR S51 OR S52 OR S53 OR S54

S56 (MH “Substance Dependence”)

S57 “drug dependence”

S58 alcohol dependence

S59 (MH “Substance Abuse, Intravenous”)

S60 “addict”

S61 addictions

S62 addiction

S63 (MH “Behavior, Addictive+”)

S64 (MH “Substance Use Disorders+”)

S65 substance related disorders

S66 (MH “Alcohol Drinking”)

S67 (MM “Alcohol Drinking”)

S68 substance abuse

S69 (MM “Substance Abuse (Saba CCC)”)

S70 (MM “Alcoholism”) OR (MM “Alcohol Abuse”) OR (MM “Substance Abuse”)

S71 (MM “Stress Disorders, Post-Traumatic”)

S72 (MM “Anxiety”)

S73 mood disorders

S74 (MM “Affective Disorders”)

S75 (MM “Dysthymic Disorder”)

S76 major depressive disorder

S76 (MM “Depression”)

S77 mental illness

S78 (MH “Mental Disorders+”)

S79 (MH “Mental Health Services+”)

S80 S56 OR S57 OR S58 OR S59 OR S60 OR S61 OR S62 OR S63 OR S64 OR S65 OR S66 OR S67 OR S68 OR S69 OR S70 OR S71 OR S72 OR S73 OR S74 OR S75 OR S76 OR S77 OR S78 OR S79

S81 S25 AND (S38 OR S55) AND S80 limit results to English

Cochrane searched 1/19/2011 results 319

“mental illness” or depression or anxiety or “mental health” or “mental disorders” or “dysthymic disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction” or “substance related disorders” or “addictive behavior” or “addictive behaviors” or addiction or addict or addicts or “substance abuse” or “intravenous drug use” or “drug dependence” :ti,ab,kw

AND

(insurance or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care” or “health maintenance organizations” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts”):ti,ab,kw

Embase (OVID) searched 10/8/2010 results 11,013

1. Exp Mental Health Service/
2. . *mental health service/
3. Exp mental disease/co,dt,ep,pc,th
4. *mental disease/co,dt,ep,pc,th
5. Mental illness.mp.
6. *depression/
7. Depressive disorders.mp.
8. *depressive disorder, major/
9. *dysthymic disorder/
10. *mood disorders/
11. *anxiety/
12. *stress disorders, post traumatic/
13. Or/1-12
14. Alcohol abuse.mp.
15. Drug abuse.mp.
16. Substance abuse.mp.
17. Exp alcohol drinking/
18. *alcohol drinking/
19. Exp substance-related disorders/
20. *substance-related disorders/
21. Exp behavior, addictive/
22. *behavior, addictive/
23. Addiction$.mp.
24. Addict.mp.
25. Exp substance abuse, intravenous/
26. *substance abuse, intravenous/
27. Alcohol dependence.mp.
28. Drug dependence.mp.
29. Substance dependence.mp.
30. Or/14-29
31. 13 or 30
32. Exp insurance coverage/
33. *insurance coverage/
34. Exp insurance, psychiatric/
35. *insurance, psychiatric/
36. Exp insurance, health/
37. *insurance, health/
38. Exp health benefit plans, employee/
39. *health benefit plans, employee/
40. Exp health expenditures/
41. *health expenditures/
42. Exp comprehensive health care/
43. *comprehensive health care/
44. Exp universal coverage/
45. *universal coverage/
46. Exp managed care programs/
47. *managed care programs/
48. Exp insurance benefits/
49. *insurance benefits/
50. Exp medically uninsured/
51. *medically uninsured/
52. Exp “Deductibles and coinsurance”/
53. *”deductibles and coinsurance”/
54. Carve-outs.mp.
55. carve-outs.ti,ab.
56. carveout.mp.
57. carveout.ti,ab.
58. carve-out.mp.
59. carve-out.ti,ab.
60. or/32-59
61. exp health services accessibility/
62. *health services accessibility/
63. exp “delivery of health care”/
64. *delivery of health care/
65. exp delivery of health care, integrated/
66. *delivery of health care, integrated/
67. exp community mental health services/
68. *community mental health services/
69. exp community health centers/
70. *community health centers/
71. outpatient sevies.mp.
72. utilization.mp.
73. specialty visit$.mp.
74. or/61-73
75. exp legislation as topic/
76. exp jurisprudence/
77. *jurisprudence/
78. mental health parity.mp.
79. mental health parity.ti.
80. mental health parity legislation.mp.
81. mental health parity legislation.ti.
82. substance abuse parity.mp.
83. substance abuse parity.ti.
84. substance abuse parity legislation.mp.
85. substance abuse parity legislation.ti.
86. parity.mp.
87. parity legislation.mp.
88. parity law$.mp.
89. (mandate or mandates or mandated).mp.
90. regulation$.mp.
91. equality.mp.
92. (policy or policies).mp.
93. exp health policy/
94. *health policy/
95. exp healthcare disparities/
96. *healthcare disparities/
97. exp health care reform/
98. *health care reform/
99. exp employee retirement income security act/
100. *employer retirement income security act/
101. or/75-100
102. 31 and 60 and 101
103. 31 and 74 and 101
104. 102 or 103
105. .limit 104 to (English and humans)

RESULTS=11013 for search performed on 10/8/2010

Database: ERIC (CSA) searched 1/14/2011 results 49

(“health services accessibility” or “access to health services” or “health services access” or “health care delivery” or “delivery of health care” or “integrated health care delivery” or “integrated delivery of health care” or “delivery of integrated health care” or “community mental health centers” or “community mental health services” or “outpatient services” or “utilization” or “health care utilization” or “social services utilization” or “specialty visit” OR “specialty visits”)

And

(“legislation” or “statutes” or “jurisprudence” or “mental health parity” or “mental health parity legislation” or “substance abuse parity legislation” or “substance abuse parity” or parity or “parity legislation” or “parity law” or “parity laws” or “mandate/mandates” or mandate or mandates or mandated or “regulation” or “government regulation” or “equality” or “health care services policy” or “health policy” or “employee retirement income security act” or “health care reform” or “healthcare disparities” or “health care disparities”)

And

(“mental illness” or “depression psychology” or anxiety” or “mental health services” or “mental disorders” or “dysthymic disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction” or “substance related disorders” or “addictive behavior” OR “addictive behaviors” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” OR “intravenous drug use” OR “intravenous drug abuse” or “drug addiction” or “drug dependence”)

Lexis/Nexis Searched 01/28/2011 results 496

LILACS http://lilacs.bvsalud.org/en/ searched 1/24/2011 results 4

insurance or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care” or “health maintenance organizations” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts”

and

“mental illness” or depression or anxiety or “mental health” or “mental disorders” or “dysthymic disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction” or “substance related disorders” or “addictive behavior” or “addictive behaviors” or addiction or addict or addicts or “substance abuse” or “intravenous drug use” or “drug dependence” or “health services accessibility” or “access to health services” or “health services access” or”health care delivery” or “delivery of health care” or “delivery of integrated health care” or “community mental health centers” or “community mental health services” or “outpatient services” or “utilization” or “specialty visit” OR “specialty visits”

and

legislation or statutes or jurisprudence or parity or mandate or mandates or mandated or regulation or equality” or “health care services policy” or “health policy” or “employee retirement income security act” or “health care reform” or “healthcare disparities” or “health care disparities”

National Council on State Legislatures searched on 1/29/2011 results 39

searched “mental insurance parity”

National Research Register searched 1/30/2011 results 0 (zero)

searched insurance parity

NTIS (National Technical Information Service) searched 1/25/2011 results 18

searched insurance parity

Database(s): PsycINFO 1806 to January Week 2 2011 searched on 1/19/2011 results 3,207 Search Strategy:

# Searches Results

1. exp mental health services/ 26980
2. *mental health services/ 18306
3. exp mental disorders/ 354033
4. *mental disorders/ 43532
5. mental illness.mp. 23591
6. *”depression (emotion)”/ 16191
7. *major depression/ 57350
8. *dysthymic disorder/ 977
9. *affective disorders/ 7622
10. *anxiety/ 27867
11. *posttraumatic stress disorder/ 13863
12. or/1-11 413076
13. *alcohol abuse/ 9123
14. alcohol abuse.mp. 16017
15. *drug abuse/ 23826
16. drug abuse.mp. 35847
17. substance abuse.mp. 21967
18. *alcoholism/ 18860
19. *alcohol drinking patterns/ 12525
20. alcohol drinking.mp. 16495
21. *drug dependency/ 6998
22. substance related disorder$1.mp. 480
23. addiction/ 4361
24. *addiction/ 3493
25. addict$1.mp. 6288
26. exp intravenous drug usage/ 2561
27. *intravenous drug usage/ 2177
28. alcohol dependence.mp. 5327
29. drug dependence.mp. 2356
30. substance dependence.mp. 1339
31. or/13-30 98043
32. 12 or 31 492557
33. insurance coverage.mp. 983
34. “uninsured (health insurance)”/ or “underinsured (health insurance)”/ 50
35. exp health insurance/ 5304
36. exp insurance/ 6264
37. employee benefits/ 809
38. employee health insurance/ 138
39. exp employee health insurance/ 487
40. health benefit$1 plan$.mp. 8
41. health expenditures.mp. 130
42. comprehensive health care.mp. 115
43. interdisciplinary treatment approach/ 5271
44. *interdisciplinary treatment approach/ 4214
45. universal coverage.mp. 58
46. managed care/ 2558
47. *managed care/ 2149
48. managed care program$1.mp. 130
49. insurance benefits.mp. 136
50. exp “Uninsured (Health Insurance)”/ 49
51. medically uninsured.mp. 6
52. deductible.mp. 44
53. coinsurance.mp. 24
54. carve-out.mp. 225
55. carve-outs.mp. 50
56. carve-outs.ti,ab. 49
57. carve-out.ti,ab. 224
58. carveout.mp. 6
59. carveout.ti,ab. 6
60. carveouts.mp. 5
61. carveouts.ti,ab. 4
62. or/33-61 15219
63. health services accessibility.mp. 1
64. accessibility of health services.mp. 10
65. access to health services.mp. 177
66. health services access.mp. 30
67. exp Health Care Delivery/ 22457
68. *health care delivery/ 10566
69. integrated services/ 1856
70. *integrated services/ 1552
71. exp community services/ 21381
72. *community services/ 8429
73. exp community mental health services/ 5871
74. *community mental health services/ 5084
75. community mental health centers/ 2208
76. *community mental health centers/ 1906
77. community health centers.mp. 236
78. *outpatient treatment/ 3377
79. exp outpatient treatment/ 4764
80. outpatient services.mp. 726
81. health care utilization/ 9717
82. *health care utilization/ 8131
83. utilization.mp. 24995
84. specialty visit$.mp. 0
85. or/63-84 71564
86. legislation.mp. 8238
87. legislative processes/ 1582
88. jurisprudence.mp. 756
89. mental health parity/ 43
90. mental health parity.mp. 82
91. mental health parity legislation.mp. 10
92. mental health parity legislation.ti. 1
93. substance abuse parity.mp. 3
94. substance abuse parity.ti. 1
95. substance abuse parity legislation.mp. 1
96. substance abuse parity legislation.ti. 0
97. parity.mp. 1865
98. parity legislation.mp. 35
99. parity law$.mp. 27
100. (mandate or mandates or mandated).mp. 6255
101. regulation$.mp. 42939
102. equality.mp. 8210
103. health equity.mp. 86
104. (policy or policies).mp. 77043
105. exp health care policy/ 5119
106. *health care policy/ 3632
107. health policy.mp. 3034
108. healthcare disparit$.mp. 59
109. health care reform/ 651
110. *health care reform/ 542
111. health care disparit$.mp. 169
112. employee retirement income security act.mp. 12
113. or/86-112 137289
114. 32 and 62 and 113 787
115. 32 and 85 and 113 2862
116. 114 or 115 3207

PubMed Strategy 1/12/2011 results 141 (searched to pick up any additional articles not found in Ovid Medline search)

Mental[Title] and parity[Title]

SIGLE Searched System for Information on Grey Literature in Europe (http://www.opengrey.eu/) searched 1/30/2011 results 0 (zero)

Searched mental insurance parity

Sociological Abstracts searched 1/14/2011 results 136

((((“health insurance”)) or(“insurance coverage”) or(“psychiatric insurance”) or(“benefits”) or(“health expenditures”) or(“comprehensive health care”) or(“universal coverage”) or((“managed care services” or “health maintenance organizations”)) or(“managed care programs”) or(“insurance benefits”) or(“medically uninsured”) or(deductible or deductibles or coinsurance) or(“carve-out” or “carve-outs” or “carveout” or “carveouts”)) and(((“mental illness”) or(“depression psychology”) or(“anxiety”)) or(“mental health services”) or(“mental disorders”) or(“dysthymic disorders”) or(“post traumatic stress”) or((“substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction”)) or(“substance related disorders”) or(“addictive behavior” OR “addictive behaviors”) or((“addiction” or “drug addiction”)) or(addict or addicts) or(“intravenous substance abuse” OR “intravenous drug use” OR “intravenous drug abuse”) or(“drug addiction”) or(“drug dependence”)) and(((“legislation” or “statutes”)) or(“jurisprudence”) or(“mental health parity”) or(“mental health parity legislation”) or(“substance abuse parity legislation” or “substance abuse parity” or parity or “parity legislation” or “parity law” or “parity laws”) or(“mandate/mandates”) or(mandate or mandates or mandated) or((“regulation” or “government regulation”)) or(“equality”) or((“health care services policy” or “health policy”)) or(“employee retirement income security act”) or (“health care reform”) or (“healthcare disparities”) or (“health care disparities”))) or((((“mental illness”) or(“depression psychology”) or(“anxiety”)) or(“mental health services”) or(“mental disorders”) or(“dysthymic disorders”) or(“post traumatic stress”) or((“substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction”)) or(“substance related disorders”) or(“addictive behavior” OR “addictive behaviors”) or((“addiction” or “drug addiction”)) or(addict or addicts) or(“intravenous substance abuse” OR “intravenous drug use” OR “intravenous drug abuse”) or(“drug addiction”) or(“drug dependence”)) and((“health services accessibility” or “access to health services” or “health services access”) or(“health care delivery” or “delivery of health care”) or(“integrated health care delivery” or “integrated delivery of health care” or “delivery of integrated health care”) or(“community mental health centers”) or(“community mental health services”) or(“outpatient services”) or((“utilization” or “health care utilization” or “social services utilization”)) or(“specialty visit” OR “specialty visits”)) and(((“legislation” or “statutes”)) or(“jurisprudence”) or(“mental health parity”) or(“mental health parity legislation”) or(“substance abuse parity legislation” or “substance abuse parity” or parity or “parity legislation” or “parity law” or “parity laws”) or(“mandate/mandates”) or(mandate or mandates or mandated) or((“regulation” or “government regulation”)) or(“equality”) or((“health care services policy” or “health policy”)) or(“employee retirement income security act”) or (“health care reform”) or (“healthcare disparities”) or (“health care disparities”)))

Web of Science searched 1/23/2011 results 340

#1 AND #2 AND #3

#3 TS=(“health insurance” or “insurance coverage” or “psychiatric insurance” or “benefits” or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care services” or “health maintenance organizations” or “managed care programs” or “insurance benefits” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts” Or “health services accessibility” or “access to health services” or “health services access” or “health care delivery” or “delivery of health care” or “integrated health care delivery” or “integrated delivery of health care” or “delivery of integrated health care” or “community mental health centers” or “community mental health services” or “outpatient services” or “utilization” or “health care utilization” or “social services utilization” or “specialty visit” OR “specialty visits” ) AND Language=(English)

#2 TS=(“legislation” or “statutes” or “jurisprudence” or “mental health parity” or “mental health parity legislation” or “substance abuse parity legislation” or “substance abuse parity” or parity or “parity legislation” or “parity law” or “parity laws” or mandate or mandates or mandated or “regulation” or “government regulation” or “equality” or “health care services policy” or “health policy” or “employee retirement income security act” or “health care reform” or “healthcare disparities” or “health care disparities”) AND Language=(English)

#1 TS=(“mental illness” or depression psychology or “anxiety” or “mental health services” or “mental disorders” or “dysthymic disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction” or “substance related disorders” or “addictive behavior” OR “addictive behaviors” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” OR “intravenous drug use” OR “intravenous drug abuse” or “drug addiction” or “drug dependence”) AND Language=(English)

Economic Review

The economic review is based on evidence from the Community Guide search for effectiveness evidence (search period January 1950 – March 2011) and a separate focused search for economic evidence (search period January 1950 February 2011).

The focused economics search examined eight bibliographic databases: Pubmed, CRD at York, EconLit, Business and Economics, Embase, JSTOR, and SSCI. The types of documents retrieved by the search included journal articles, books, book chapters, reports, and conference papers.

Search terms and strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software.

Database:PUBMED (NLM)

Date Searched: September 2010
Results: 3847
Date of Update Search: 2/4/2011
Results: 48

Search Strategy:

Search: ((“alcohol abuse”[all fields] OR “drug abuse”[all fields] OR “substance abuse”[all fields] OR “alcohol drinking”[mesh] OR “substance-related disorders”[mesh] OR “behavior, addictive”[mesh] OR addiction OR addictions OR addict OR “substance abuse, intravenous”[mesh] OR “alcohol dependence”[all fields]) OR (“mental health services”[MeSH Terms] OR “mental health services”[All Fields] OR “mental disorders”[MeSH Terms] OR “mental disorders”[All Fields] OR “mental illness”[All Fields] OR “mental illnesses”[All Fields] OR “depressive disorder”[MeSH Terms] OR “depression”[MeSH Terms] OR “depressive disorder, major”[MeSH Terms] OR “dysthymic disorder”[MeSH Terms] OR “mood disorders”[MeSH Terms] OR “anxiety”[MeSH Terms] OR “stress disorders, post-traumatic”[MeSH Terms])) AND ((“insurance coverage”[mesh] OR “insurance, psychiatric”[mesh] OR “insurance, health”[mesh] OR “health benefit plans, employee”[mesh] OR “health expenditures”[mesh] OR “comprehensive health care”[mesh] OR “universal coverage”[mesh] OR “managed care programs”[mesh] OR “insurance benefits”[mesh] OR “medically uninsured”[mesh] OR “deductibles and coinsurance”[mesh] OR “carve-outs”[all fields] OR “carve-out”[all fields] OR “carveouts”[all fields] OR “carveout”[all fields]) OR (“health services accessibility”[mesh] OR “delivery of health care”[mesh] OR “delivery of health care, integrated”[mesh] OR “community mental health services”[mesh] OR “community health centers”[mesh] OR “outpatient services”[all fields] OR utilization[all fields] OR “specialty visit”[all fields] OR “specialty visits”[all fields])) AND (“legislation as topic”[mesh] OR jurisprudence[mesh] OR parity[all fields] OR mandate[all fields] OR mandates[all fields] OR mandated[all fields] OR regulation[all fields] OR regulations[all fields] OR equality[all fields] OR policy[all fields] OR policies[all fields] OR “health policy”[mesh] OR “healthcare disparities”[mesh] OR “health care reform”[mesh] OR “employee retirement income security act”[mesh]) AND ((budget[mesh] OR economics[mesh] OR “costs and cost analysis”[mesh] OR “cost sharing”[mesh] OR “economics, medical”[mesh] OR “financial management”[mesh] OR “health expenditures”[mesh] OR “cost-benefit analysis”[mesh] OR “health care costs”[mesh] OR budget[all fields] OR budgets[all fields] OR “budgeting”[all fields] OR economic[all fields] OR “economics”[all fields] OR cost[all fields] OR costs[all fields] OR finance[all fields] OR finances[all fields] OR financing[all fields] OR expenditure[all fields] OR expenditures[all fields] OR “benefit design”[all fields] OR “benefit plan”[all fields] OR “cost benefit”[all fields] OR “cost effective”[all fields] OR “cost utility”[all fields] OR qaly[all fields] OR efficiency[all fields] OR dollar[all fields] OR dollars[all fields] OR “cost model”[all fields] OR “cost models”[all fields] OR “cost modeling”[all fields] OR “labor market”[all fields] OR “labor markets”[all fields]) OR (“cost sharing”[all fields] OR “out-of-pocket”[all fields] OR “cost of illness”[mesh] OR “catastrophic illness”[mesh] OR “out-of-burden”[all fields] OR “out-of-burdens”[all fields] OR “economic burden”[all fields] OR “economic burdens”[all fields] OR “financial burden”[all fields] OR “financial burdens”[all fields] OR “financing, personal”[mesh] OR “medical debt”[mesh] OR “medical debts”[mesh] OR “medical bankruptcy”[mesh] OR “catastrophic cost”[all fields] OR “catastrophic costs”[all fields] OR “financial protection”[all fields] OR “financial protections”[all fields] OR “financial ruin”[all fields] OR “financial security”[all fields] OR “income security”[all fields] OR “financial distress”[all fields]))

Database: CRD-York

Date Searched: 2/1/2011
Results: 18

Search Strategy:

(“mental illness” or depression or anxiety or “mental health services” or “mental disorders” or “dysthymic disorders” or “mood disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “alcohol dependence” or “alcohol drinking” or “drug abuse” or “substance related disorders” or “addictive behavior” or “addictive behaviors” or “addiction” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” or “intravenous drug use” or “intravenous drug abuse” or “drug dependence”)

AND

(“health insurance” or “insurance coverage” or “psychiatric insurance” or “benefits” or “health benefit plan” or “health benefit plans” or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care services” or “health maintenance organizations” or “managed care programs” or “insurance benefits” or “insurance benefit” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts”)

Database: ECONLIT (EBSCOHost)

Date Searched: 2/3/2011
Results: 87

Search Strategy:

S1 (“mental illness” or depression or anxiety or “mental health services” or “mental disorders” or “dysthymic disorders” or “mood disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “alcohol dependence” or “alcohol drinking” or “drug abuse” or “substance related disorders” or “addictive behavior” or “addictive behaviors” or “addiction” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” or “intravenous drug use” or “intravenous drug abuse” or “drug dependence”)

S2 (“health insurance” or “insurance coverage” or “psychiatric insurance” or “benefits” or “health benefit plan” or “health benefit plans” or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care services” or “health maintenance organizations” or “managed care programs” or “insurance benefits” or “insurance benefit” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts”)

S3 S1 and S2

Database: Business & Economics (EBSCOHost)

Date Searched: 1/31/2011
Results: 422

Search Strategy:

S1 (“mental illness” or depression or anxiety or “mental health services” or “mental disorders” or “dysthymic disorders” or “mood disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “alcohol dependence” or “alcohol drinking” or “drug abuse” or “substance related disorders” or “addictive behavior” or “addictive behaviors” or “addiction” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” or “intravenous drug use” or “intravenous drug abuse” or “drug dependence”)

S2 (“health insurance” or “insurance coverage” or “psychiatric insurance” or “benefits” or “health benefit plan” or “health benefit plans” or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care services” or “health maintenance organizations” or “managed care programs” or “insurance benefits” or “insurance benefit” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts”)

S3 S1 and S2

S4 (budget or budgets or economic or economics or costs or “cost analysis” or cost or “financial management” or “health expenditure” or “health expenditures” or “cost benefit analysis” or finance or finances or financing or expenditure or expenditures or “benefit design” or “benefit plan” or “benefit plans” or “cost benefit” or qaly or efficiency or dollar or dollars or “cost modeling” or “costs modeling” or “labor market” or “labor markets” or “cost sharing” or “out of pocket spending” or “out of pocket cost” or “out of pocket costs” or “cost of illness” or “catastrophic illness” or “catastrophic illnesses” or “out of pocket expense” or “out of pocket expenses” or “out of burden” or “out of burdens” or “financial burden” or “financial burdens” or “personal financing” or “medical debt” or “medical debts” or “medical bankruptcy” or “catastrophic cost” or “catastrophic costs” or “financial protection” or “financial protections” or “financial ruin” or “financial security” or “income security” or “financial distress” or “out-of-network” )

S5 S3 and S4

Database: Embase (OVID)

Date Searched: September 2010
Results: 3735
Date of Update Search: 2/5/2011
Results: 150

Search Strategy:

1 (“mental illness” or depression or anxiety or “mental health services” or “mental disorders” or “dysthymic disorders” or “mood disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “alcohol dependence” or “alcohol drinking” or “drug abuse” or “substance related disorders” or “addictive behavior” or “addictive behaviors” or “addiction” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” or “intravenous drug use” or “intravenous drug abuse” or “drug dependence”).mp.

2 (“health insurance” or “insurance coverage” or “psychiatric insurance” or “benefits” or “health benefit plan” or “health benefit plans” or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care services” or “health maintenance organizations” or “managed care programs” or “insurance benefits” or “insurance benefit” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts”).mp.

3 (legislation or statutes or jurisprudence or parity or mandate or mandates or mandated or regulation or regulations or equality or “health care services policy” or “health policy” or “employee retirement income security act” or “health care reform” or “healthcare disparities” or “health care disparities” or “equality” or “employee retirement income security act” or “health services accessibility” or “access to health services” or “health services access” or “health care delivery” or “delivery of health care” or “integrated health care delivery” or “integrated delivery of health care” or “delivery of integrated health care” or “community mental health centers” or “community mental health services” or “community health centers” or “community health center” or “outpatient services” or “utilization” or “specialty visit” or “specialty visits”).mp.

4 (budget or budgets or economic or economics or costs or “cost analysis” or cost or “financial management” or “health expenditure” or “health expenditures” or “cost benefit analysis” or finance or finances or financing or expenditure or expenditures or “benefit design” or “benefit plan” or “benefit plans” or “cost benefit” or qaly or efficiency or dollar or dollars or “cost modeling” or “costs modeling” or “labor market” or “labor markets” or “cost sharing” or “out of pocket spending” or “out of pocket cost” or “out of pocket costs” or “cost of illness” or “catastrophic illness” or “catastrophic illnesses” or “out of pocket expense” or “out of pocket expenses” or “out of burden” or “out of burdens” or “financial burden” or “financial burdens” or “personal financing” or “medical debt” or “medical debts” or “medical bankruptcy” or “catastrophic cost” or “catastrophic costs” or “financial protection” or “financial protections” or “financial ruin” or “financial security” or “income security” or “financial distress” or “out-of-network”).mp.

5 1 and 2 and 3 and 4

Database: JSTOR

Date Searched: 2/3/2011
Results: 195

Search Strategy:

( (“mental illness” or depression or anxiety or “mental health services” or “mental disorders” or “dysthymic disorders” or “mood disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “alcohol dependence” or “alcohol drinking” or “drug abuse” or “substance related disorders” or “addictive behavior” or “addictive behaviors” or “addiction” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” or “intravenous drug use” or “intravenous drug abuse” or “drug dependence”) )

AND

(“health services accessibility” or “access to health services” or “health services access” or “health care delivery” or “delivery of health care” or “integrated health care delivery” or “integrated delivery of health care” or “delivery of integrated health care” or “community mental health centers” or “community mental health services” or “community health centers” or “community health center” or “outpatient services” or “utilization” or “specialty visit” or “specialty visits”)

AND

(legislation or statutes or jurisprudence or parity or mandate or mandates or mandated or regulation or regulations or equality or “health care services policy” or “health policy” or “employee retirement income security act” or “health care reform” or “healthcare disparities” or “health care disparities” or “equality” or “employee retirement income security act” )

AND

(budget or budgets or economic or economics or costs or “cost analysis” or cost or “financial management” or “health expenditure” or “health expenditures” or “cost benefit analysis” or finance or finances or financing or expenditure or expenditures or “benefit design” or “benefit plan” or “benefit plans” or “cost benefit” or qaly or efficiency or dollar or dollars or “cost modeling” or “costs modeling” or “labor market” or “labor markets” or “cost sharing” or “out of pocket spending” or “out of pocket cost” or “out of pocket costs” or “cost of illness” or “catastrophic illness” or “catastrophic illnesses” or “out of pocket expense” or “out of pocket expenses” or “out of burden” or “out of burdens” or “financial burden” or “financial burdens” or “personal financing” or “medical debt” or “medical debts” or “medical bankruptcy” or “catastrophic cost” or “catastrophic costs” or “financial protection” or “financial protections” or “financial ruin” or “financial security” or “income security” or “financial distress” or “out-of-network”)

Database: Social Sciences Citation Index (Web of Science )

Date Searched: 2/2/2011
Results: 1821

Search Strategy:

#12
#11 OR #10

#11
#7 AND #5 AND #4 AND #1

#10
#9 AND #8

#9
#7 AND #5 AND #1

#8
ti=(budget* or economic* or cost or costs or financing or finance or expenditure* or benefit or utility or utilization or “health coverage” or qaly or efficiency or dollar or “out-of-pocket” or debt or financial or burden or bankruptcy or ruin or security)

#7
TS=(budget* or economic* or cost or costs or financing or finance or expenditure* or benefit or utility or utilization or “health coverage” or qaly or efficiency or dollar or “out-of-pocket” or debt or financial or burden or bankruptcy or ruin or security)

#6
TI=(“health insurance” or “insurance coverage” or “psychiatric insurance” or “benefits” or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care services” or “health maintenance organizations” or “managed care programs” or “insurance benefits” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts” Or “health services accessibility” or “access to health services” or “health services access” or “health care delivery” or “delivery of health care” or “integrated health care delivery” or “integrated delivery of health care” or “delivery of integrated health care” or “community mental health centers” or “community mental health services” or “outpatient services” or “utilization” or “health care utilization” or “social services utilization” or “specialty visit” OR “specialty visits” )

#5
TS=(“health insurance” or “insurance coverage” or “psychiatric insurance” or “benefits” or “health expenditures” or “comprehensive health care” or “universal coverage” or “managed care services” or “health maintenance organizations” or “managed care programs” or “insurance benefits” or “medically uninsured” or deductible or deductibles or coinsurance or “carve-out” or “carve-outs” or “carveout” or “carveouts” Or “health services accessibility” or “access to health services” or “health services access” or “health care delivery” or “delivery of health care” or “integrated health care delivery” or “integrated delivery of health care” or “delivery of integrated health care” or “community mental health centers” or “community mental health services” or “outpatient services” or “utilization” or “health care utilization” or “social services utilization” or “specialty visit” OR “specialty visits” )

#4
TS=(“legislation” or “statutes” or “jurisprudence” or “mental health parity” or “mental health parity legislation” or “substance abuse parity legislation” or “substance abuse parity” or parity or “parity legislation” or “parity law” or “parity laws” or mandate or mandates or mandated or “regulation” or “government regulation” or “equality” or “health care services policy” or “health policy” or “employee retirement income security act” or “health care reform” or “healthcare disparities” or “health care disparities”)

#3
TI=(“legislation” or “statutes” or “jurisprudence” or “mental health parity” or “mental health parity legislation” or “substance abuse parity legislation” or “substance abuse parity” or parity or “parity legislation” or “parity law” or “parity laws” or “mandate” or “mandates” or mandate or mandates or mandated or “regulation” or “government regulation” or “equality” or “health care services policy” or “health policy” or “employee retirement income security act” or “health care reform” or “healthcare disparities” or “health care disparities”)

#2
TI=(“mental illness” or depression psychology or “anxiety” or “mental health services” or “mental disorders” or “dysthymic disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction” or “substance related disorders” or “addictive behavior” OR “addictive behaviors” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” OR “intravenous drug use” OR “intravenous drug abuse” or “drug addiction” or “drug dependence”)

#1
TS=(“mental illness” or depression psychology or “anxiety” or “mental health services” or “mental disorders” or “dysthymic disorders” or “post traumatic stress” or “substance abuse” or “alcohol abuse” or “drug abuse” or “drug addiction” or “substance related disorders” or “addictive behavior” OR “addictive behaviors” or “addiction” or “drug addiction” or addict or addicts or “intravenous substance abuse” OR “intravenous drug use” OR “intravenous drug abuse” or “drug addiction” or “drug dependence”)

American Psychological Association. Mental health insurance under the federal parity law. 2010. Available at URL: http://www.apa.org/helpcenter/federal-parity-law.aspx

Cauchi R, Landess S, Thangasamy A. State laws mandating or regulating mental health benefits. 2011. National Conference of State Legislatures. Available at URL: http://www.ncsl.org/issues-research/health/mental-health-benefits-state-laws-mandating-or-re.aspx

Employee Benefits Security Administration. Fact Sheet: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). United States Department of Labor. 2010. Available at URL: http://www.dol.gov/ebsa/newsroom/fsmhpaea.html

Sarata A. Mental health parity and the patient protection and Affordable Care Act of 2010. Congressional Research Service, 2011. Available at URL: http://www.ncsl.org/documents/health/MHparity&mandates.pdf.

Solis. 2012 Report to Congress: Compliance with the mental health parity and addiction equity act of 2008. Unites States Department of Labor. 2010. Available at URL: http://www.dol.gov/ebsa/publications/mhpaeareporttocongress2012.html

Zuvekas SH, Banthin JS, Selden TM. Mental health parity: What are the gaps in coverage? J Ment Health Policy Econ 1998;1:135 146.

Challenges to effective implementation of MHBL include underutilization, access to services, and exemptions.

• Underutilization:
  • It is unclear to what extent MHBL reduces public stigma, a barrier to utilization of services.
  • Low awareness of legislative provisions also may hinder service use by beneficiaries.
• Access to Services:
  • Limited numbers of mental health providers and inpatient beds restrict access to services, especially in rural areas.
  • In some cases, covered services and treatments are not clearly defined in the legislation, allowing individual health plans to limit benefits provided for certain conditions or illnesses.
  • Investigational treatments typically are not covered by insurance plans.
• Exemptions:
  • Larger employers often self-insure, and are therefore exempt from mental health insurance related state mandate laws because of the 1974 Employee Retirement Income Security Act (ERISA).
  • Both employers with fewer than 50 employees and group health plans that demonstrate a mental health benefit related cost increase of 1% (MHPA) and 2% (MHPAEA) are exempt from the respective federal legislation.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Increase the proportion of children with mental health problems who get treatment — MHMD‑03
• Increase the proportion of adults with serious mental illness who get treatment — MHMD‑04
• Increase the proportion of adults with depression who get treatment — MHMD‑05
• Increase the proportion of adolescents with depression who get treatment — MHMD‑06
• Increase the proportion of children and adolescents who get appropriate treatment for anxiety or depression — EMC‑D04