The disconnect between policy and practice: evaluating access to behavioral health resources under the Mental Health Parity and Addiction Equity Act

The enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 sought to eliminate longstanding discriminatory insurance practices against behavioral health disorders by requiring health insurers of large group plans to apply no more restrictive financial requirements and treatment limitations to mental health and substance use disorder benefits relative to those applied to medical/surgical benefits. Since the parity act went into effect in 2010, the prevalence of mental health conditions has continued to rise while the proportion of those seeking mental health services has remained stagnant. As a result, an increasing trend in the percentage of Americans with a perceived unmet need for behavioral health services has been observed over the past decade. Many of those with an unmet need for services cite an inability to afford the cost of care, no insurance/underinsurance, and/or lack of available behavioral health clinicians as some of the primary reasons for not obtaining wanted care. This suggests a disconnect exists between the policy and practice of parity that warrants further investigation. Understanding the history of behavioral health coverage and parity in the United States and the current structure of America’s health insurance system provides context for why healthcare reform legislations, like the MHPAEA, are necessary. Furthermore, dissecting the provisions and limitations of the MHPAEA and the Affordable Care Act’s impact on behavioral health parity exposes barriers that perpetuate the disconnect between policy and practice. The various barriers that continue to limit access to behavioral health care despite the MHPAEA will be evaluated to better understand why they exist and how they facilitate a persistent unmet need. Mental health in America is a critical medical and public health concern as the prevalence of poor mental health has continued to grow, especially amidst the COVID-19 pandemic. The shortcomings of current legislation and the mental health care delivery system need to be addressed to develop future legislation that can be better equipped to deliver true parity in practice