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This Special Issue* of Psychodynamic Psychiatry, “Psychotherapy, the Affordable Care Act and Mental Health Parity: Obstacles to Implementation,” is written to address a moment of both crisis and opportunity with respect to the health of the nation. The ongoing crisis lies in the psychiatric illness that affects one half of the population during some point in their lifetimes; illness which is stigmatized, undiagnosed, and more often than not, treated inadequately if treated at all. Untreated psychiatric patients fill our jails and the ranks of the homeless. Undertreated psychiatric illness leads to enormous losses in the form of increased healthcare costs, disability, morbidity, mortality, diminished productivity, and human suffering.
Opportunity lies in the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) mandating the provision of mental health care at parity with all other medical care and the fact that the 2010 Affordable Care Act (ACA) mandates mental health care including psychotherapy as one of the 10 Essential Health Benefits. But significant obstacles to this breakthrough legislation remain, particularly in protocols used by insurance companies to rationalize limitations on treatment consistent with immediate cost considerations but not with clinical needs.
In the May 3, 2014 Director's Blog: The Paradox of Parity from The National Institute of Mental Health, Director Thomas Insel raises the concern about coverage for efficacious psychosocial treatments and states that “we care deeply that those non-pharmacological treatments that have been shown to be helpful are disseminated and reimbursed broadly … It would be a sad irony if in the era of parity only those who could afford to pay out of pocket could get access to effective psychosocial treatments.”