1. Go beyond the stereotypes of mental illness.
Avoid prejudging those with mental illness on the basis of societal & media stereotypes. Resist the negative stereotypes that often cloud our thinking about mental illness.
2. Learn more about mental illness.
The more informed we are, the better we are able to evaluate and resist the inaccurate negative stereotypes that are so common.
3. Learn more about stigma & discrimination.
There is substantial literature on stigma. Use it to learn as much as you can to fight discrimination.
4. Listen to people who experience mental illness.
Those with mental illness are I the best position to describe what they find as stigmatizing, what they would like us to know about living with mental illness, and how they would like to be viewed & treated.
5. Monitor media & respond to stigmatizing material.
Mass media have substantial power to influence public thinking — that is, either to perpetuate or to reduce misconceptions about mental illness. When we encounter misconceptions, we need to let the media know our concerns about their material.
6. Speak up about stigma.
Tactfully, let someone know when they have misused a psychiatric term. When someone is disrespectful or tells a joke that ridicules mental illness, let that individual know how hurtful and offensive it is. Speaking up is empowering and educates others.
7. Watch our language.
We can all be guilty of using terms and expressions related to mental illness that perpetuates stigma.
8. Talk openly about mental illness.
The more mental illness remains hidden, the more people believe it is shameful and needs to be concealed. We need to let others see real people with mental illness — people who do not fit the stereotype — it is a powerful way to fight stigma.
9. Provide support to organizations that fight stigma.
Many organizations are devoted to education, research, and advocacy concerning mental illness. They rely on the passion and efforts of volunteer members.
10. Demand change from your elected officials.
Policies that perpetuate stigma can be changed if enough people let their representatives know that they want such change.
The long-awaited U.S. Department of Health and Human Services (HHS) proposed essential health benefits (EHB) rule guiding coverage in individual, small group and health insurance exchange plans was published today in the Federal Register.
Notable elements of the rule:
State Required Benefits (Part 155)
State required, or mandated, benefits for treatment may, if enacted before 2012, be considered essential health benefits (EHB). This means that states, at least for plan years 2014 and 2015, will not incur extra costs for such benefits.
EHB-benchmark plan standards (§ 156.110)
Supplementing the default base-benchmark plan
The proposed rule outlines the process HHS will take to supplement a state base-benchmark plan that is missing a category of coverage, such as mental health care, to ensure it is included. However, for habilitative services, HHS proposes that if the base-benchmark plan does not include habilitative services, the state may determine which services are included in that category. See Appendix A for information on whether state base-benchmark plans include habilitative services.
Provision of EHB (§ 156.115) - Benefit Substitutions
Health plans may substitute benefits within any of the required categories of coverage (such as mental health and substance abuse services), except prescription drugs. This means that plans may not substitute mental health services for additional benefits in another category, like maternity and newborn care, but may substitute benefits, including coverage limitations, within the category of mental health or substance abuse services.
Prescription Drug Benefits (§ 156.120)
Plans must cover whichever is greater: one drug in every category and class or the same number of drugs in every category and class as the state's EHB-benchmark plan. This rule slightly expands an earlier "one drug per class" proposal.
Prohibition on Discrimination (§ 156.125)
Health plan benefit design, including cost-sharing, may not result in discrimination based on age, disability or health conditions or other stated characteristics. This is an important protection for people living with mental illness and other chronic conditions.
Medicaid expansion and Essential Health Benefits
The Centers for Medicare and Medicaid Services (CMS) released a State Medicaid Directors Letter on November 20 clarifying that Medicaid expansion plans must cover all ten EHB categories, including mental health and substance use disorder services, and must comply with federal parity requirements. Unlike the proposed rule for EHB, CMS intends to issue guidance for defining habilitative benefits.
The letter reiterates that states may provide Medicaid expansion groups "benchmark" coverage based on the Federal Employees Health Benefit program, the state employee health plan, the largest HMO plan in the state or a state-designed plan that is approved by the Secretary of HHS.
Cost-benefit of expanding Medicaid
Governing magazine's David Levine provides a pithy exploration of the costs and benefits of Medicaid expansion in his article, "Killing the Medicaid Expansion Controversy." Levine cites a recent study in The New England Journal of Medicine that found that Medicaid expansion reduces the death rate, especially for minorities and people in low-income areas.
A disproportionate number of people who would be covered under Medicaid expansion plans need mental health and substance use disorder services. Despite the benefit to millions of people who need treatment, most states haven't made a decision and some are saying they will not participate.
Contact the governor in your state to encourage participation.
Iowa Governor Terry Branstad—(515) 281-5211
Illinois Governor Pat Quinn—(217) 782-0244