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General Consumer Information

Make the Best Choice for Your Mental Health Plan

Significant changes have occurred in the health insurance industry that may affect your access to quality mental health care. More employers are contracting with "managed care" plans to monitor delivery of mental health care.

Managed care companies act as gatekeepers between you and your insurance benefits, in an effort to contain costs and increase profits. Managed care companies limit benefits and dictate treatment terms. This may directly affect the quality of care you receive.

These changes can be confusing to you, the consumer, as you try to understand which insurance plan will best meet your needs. This page is designed to provide information to consider when investigating your options.

You may have questions to discuss with your benefits manager, your insurance company's representative or your psychotherapist.

If you are uncomfortable with an insurer's policies regarding choice of therapist, length or type of care, or confidentiality, you may want to know what other options you have.

You Do Have A Choice.

When You Make The Choice:

You have freedom of choice in selecting a psychotherapist who best fits your needs.

You and your therapist agree on the fee.

You decide with your therapist the length of your treatment.

You and your therapist decide what type of treatment will best meet your needs.

Your right to privacy is safeguarded. Confidentiality is protected within the limits of state law.

When Your Managed Care Plan Makes The Choice:

Your choice of psychotherapist may be limited to a short list of persons who have a contract with the company.

Your managed care insurance plan sets the fee.

The plan decides if treatment is covered, and if so, how many sessions it will pay for, based on a reviewer's judgment of need.

Type of treatment will be dictated by the plan. You may be limited to brief therapy or crisis intervention. Use of medication may be required or offered as the only treatment.

Reports are required. Records are the property of the managed care company. Managed care employees will have access to clinical information that would otherwise remain between client and therapist.

What Can You Do?

Before selecting an insurance plan, find out what mental health benefits are provided with each option available to you. Get your questions answered before you sign up.

Discuss with your psychotherapist exactly what information your insurer requires. Assess any possible impact if this information becomes accessible to others. If paying for therapy privately is too difficult for you, discuss with your therapist the possibility of flexible fees or payment schedule.

Talk to the human resources department of your workplace. Tell them your concerns and preferences.

Write or call your state and national legislators about your concerns and opinions.


About Depression

WHAT IS DEPRESSION?

Depression is more than feeling low or blue from time to time. It is an illness, and it can affect anyone. It does affect between 5 and 25 % of the population sometime during their life. Symptoms of depression include:

Feeling sad, empty, hopeless, or helpless
An inability to enjoy pleasant experiences
Major or sudden weight loss or gain
Disturbed sleep
Fatigue or loss energy
Low self esteem
Irritability
Agitation
A sense of being in slow motion or speeded up
Difficulty concentrating
Thoughts of death or suicide

There are different kinds of depression. Major Depression is a severe depression lasting at least two weeks. Dysthymia is a less severe but usually more long-lasting depression. Seasonal Affective Disorder is depression which is affected by the amount of sunlight a person is exposed to. Bipolar Disorder is depression mixed with periods of mania, where the individual needs little sleep and often acts impulsively.

WHAT CAUSES DEPRESSION?

Depression can be caused by many factors, including significant life stress, loss, family history, and biology. Sometimes the reason for a person's depression is never determined. The severity, duration, and frequency of depressive episodes are widely variable. Some people have only one episode of depression, while others experience depression on and off throughout their lives.

Depression might also be a main symptom when other major family problems exist, such as alcohol abuse. It is a problem that reaches beyond the particular individual who is depressed. Families, friends, and co-workers of a depressed person are often impacted, as relationships become strained.

HOW IS DEPRESSION TREATED?

The two main ways of treating depression are through medications and psychotherapy. Either or both of these methods can be utilized, depending on the type of depression being treated.

Medication must be prescribed by a doctor or certain types of other medical professionals working under a doctor's guidance. Psychiatrists are doctors who specialize in psychological disorders, and are most familiar with medications to treat depression.

Psychotherapy can be provided by several different types of professionals, all of whom must secure a professional license to practice therapy in California.

There are many different methods of providing therapy. A person seeking therapy for depression has the right to ask questions of the therapist they are thinking of working with. It might be important to know what the therapist's experience in working with depression is, as well as how they work toward alleviating depression.

HOW IS TREATMENT PAID FOR?

Some people pay for treatment themselves, without any contribution from a health insurance plan. Others utilize health insurance. Some health insurance plans cover the cost of medications or therapy in whole or in part. Many ask for a co-payment from the insured person. Some will cover only certain health care providers, only a certain number of sessions, or have other stipulations. Individuals who have health insurance can benefit by determining what their insurance covers, and what insurance options are available to them if they find their current insurance unsatisfactory.


It's Good for your Health

When the alarm rang at 6:00 am, Susan Smith could not possibly get out of bed. She was still exhausted, having slept poorly. Her stomach felt upset and she just didn't feel right. She called in sick, something she had been doing a lot recently. When she saw her doctor later that day, he again found nothing wrong with her physical health. Noting that she had seen him four times in the last three months with the same complaints of difficulty sleeping, poor appetite, tense stomach and lower back pain, he modified her sleeping medication and inquired about her stress level. "My boss is giving me a bad time. She says I've been missing too much work and my productivity is way down. Maybe I need a vacation."

Susan Smith is a fictitious person, but people in situations like hers are everywhere. Maybe she is depressed, anxious, or abusing a substance. She repeatedly visits her doctor when she may likely need to see a mental health professional. Meanwhile, she is using health insurance dollars to no avail and losing her company money.

Most people focus on their medical needs when shopping for health insurance, and it is an appropriate focus. The vast majority of health care dollars go towards the nation's physical, rather than psychological, health. However, as the above vignette and the following statistics indicate, an individual's psychological health is interwoven with their physical health. Broadening the focus to include both physical and psychological health in health care packages results in insurance that is a more comprehensive and accurate reflection of people's needs.

Consider these statistics:

Mental illness is the third most limiting health condition, in terms of being able to perform major daily activities, exceeded only by cancer and stroke. Regarding inability to work, mental illness is the most limiting health condition. (Mental Health Policy Resource Center, Database, 1990)

The impact of mental illness and substance abuse on workplace productivity is well documented. These disorders can impair an employee's ability to function productively, increase the chance of employee injury, and increase employee absenteeism. (American Psychological Association, Practice Directorate, June 1992)

60% of all physician visits are by people with no physical problem. This figure rises to 90% when stress-related illnesses are also included. (Gail Schapes, Ph.D., The California Psychologist, March 1992)

80% to 90% of all industrial accidents are likely related to personal problems and employees' inability to handle stress. (Neil Thakur, James M. Jacobson, J.D., American Psychological Association Practice Directorate. June. 1992)

According to the insurer Northwestern National Life, the average cost per person in lifetime disability payments for stress related illness is $73,270. However, the average cost to rehabilitate a stress-disabled employee is only $1925 -- a savings of over $71,000 per employee. (Walker, C.K., 1991, Stressed to Kill. Business and Health, Sept. p. 42)

Six of the top ten health problems chosen by over 400 corporate leaders as most seriously affecting their companies' work force can be treated by mental health professionals. The problems, along with their ranking, were: Cigarette Smoking (#2), Alcohol Abuse (#4), General Mental Health Problems (#5), Stress (#6), Drug Abuse (#9), and Depression (# 10). (Yanson, J., 1991, The National Executive Poll on Health Care Costs and Benefits. Business and Health, Sept. 1991, p.61-71)

Susan Smith's doctor referred her to a mental health professional. If she was diagnosed and treated for depression, she would have a 77% chance of a better outcome than depressed patients who did not receive treatment. (Robinson, L.A., Berman, J.S., and Neimeyer, R.A., 1990. Psychotherapy for the treatment of depression: A comprehensive review of controlled outcomes-research. Psychological Bulletin. 108, 30-49.)

If she was diagnosed and treated for panic disorder, she would have a 70-90% chance obtaining "significant relief" through psychotherapy. (Office of Scientific Information, 1992, Panic Disorder Fact Sheet, National Institute of Mental Health)

If she was diagnosed and treated for alcohol abuse, "brief motivational counseling, self control training, social skills training, and marital behavioral therapy are among the types of treatment found both most inexpensive and most effective in eliminating or reducing the effects of alcohol abuse". (Holder, H., Longabaugh, R., Miller, W.R. and Rubonis, A.V., 1991, The cost effectiveness of treatment for alcoholism: A first approximation. Journal of Studies on Alcohol, 52 (6) 517-540) Referrals to community resources, such as AA, are also part of alcohol abuse treatment.

Susan Smith, and thousands like her, suffer from mental disorders that are treatable through psychotherapy. Gone untreated, they cost employers in lost productivity and cost insurance companies in over-utilization of medical benefits. Mental health is a large part of overall health. Choose an insurance package that includes adequate and easily accessible mental health coverage. After all,

psychotherapy is good for your health.



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