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Understanding the Manic Depressive Cycle

For those with bipolar disorder, the manic depressive cycle describes the periods of and transitions between depressed and elevated moods. Rather than a smooth transition between two equidistant states, however, manic and depressive episodes often have sudden and unpredictable onsets with a range of severity ratings and transitional periods.

And yet, at the same time, each episode is sustained and distinct. This fact is a key difference between bipolar disorder and other types of mental disorders or syndromes (ADHD, depression, mood dysregulation, etc.) Moreover, an accurate and timely diagnosis is one of the biggest barriers to mental health access for many who suffer from this group of mental health issues.

 

Two-Way Suffering: Mania and Depression

To be clear, manic depressive is not a kind of depressed mood, but rather the pronounced split between these two poles of subjective mood. On the outside looking in, mania can seem like a pretty good time, but it’s rarely described that way by the individuals after the fact. This is especially true for those who feel completely out of control and/or who lose touch with reality—known as hypermania. In fact, a substantial number of individuals with bipolar disorder actually report their mania as the worse symptom to endure.

More than just what they consider worse, the reasons behind the choice are often revealing. A depressive episode is dominated by more negative feelings and overall mood, but manic episodes often carry the most serious and longest-lasting consequences. Many people also talk about having a bigger negative on the ones they love during times of mania. Nevertheless, severe depression is known as one of the worst subjective experiences an individual can go through. And a depressive episode within a bipolar disorder may be quite severe.

In theory, milder peaks can make the disorder easier to manage but also harder to identify and diagnose. This naturally leads to many individuals who are left unmonitored and untreated. And this is problematic because individuals with this milder form—known as cyclothymia—can eventually develop into full-blown bipolar disorder.

 

Transitions and Periods of Normal Mood

More than just the peaks, it’s also important to consider the in-between times. These periods, too, are quite variable and individualized. For some people, the transition is actually characterized by overlapping symptoms of mania and depression. Others may experience normal mood for many months or even years between episodes. Each manic depressive course is going to present different challenges. Individuals who recognize their mania is about to subside into depression may pose a serious risk of harming themselves out of desperation. Alternately, individuals who are in the midst of a protracted period of normal mood may become lax in the maintenance and monitoring of their mental health status.

 

Getting Help for Manic Depressive Disorder

Education is an important component of recognizing manic depressive symptoms, but it’s no substitute for a clinical assessment conducted by a qualified mental health professional. Moreover, even after the disorder is identified, individuals typically struggle or fail to manage the symptoms on their own. Depending on the individual’s current mental health status, an immediate intervention and inpatient psychiatric care may be necessary. From there, a combination treatment of prescription medication and psychotherapy are often effective in managing symptoms long-term. Don’t let any mental illness stigma or feelings of anxiety keep you from getting the help you need.

Suicide Prevention in Utah: Out of the Darkness and Walk 4 Hope

Suicide prevention and awareness never stops, but as a community, we’ve designated September as the month to organize events and make a special effort to come together for the cause. In Utah, there are several walks this month we want you to know about. If you’re so moved, please consider joining at us one of these Utah Events and/or sending a donation to the Utah Chapter of the American Foundation for Suicide Prevention. The Utah Suicide Prevention Coalition also provides support for these events.

Find more information about these events below as well as the broader organizational efforts to reduce the incidence of suicide. (Note: Provo and Utah County have their own organization and event: Walk 4 Hope run by Hope 4 Utah.)

 

When and Where are the Events in Utah?

 

Salt Lake City – Out of the Darkness Walk

Walk Date: 09/15/2018
Walk Location: Liberty Park – Salt Lake City, UT
Check-in/Registration Time: 9:00 am
Opening Ceremony: 11:00 am
Walk Begins: 11:30 am
Walk Ends: 1:00 pm

For more information, please contact:
Contact Name: Shari Elliott
Contact Phone: 801-949-6192
Contact Email: sharimarie74@yahoo.com

 

Vernal – Out of the Darkness Walk

Walk Date: 09/22/2018
Walk Location: Colton Pavilion – Vernal, UT
Check-in/Registration Time: 09/22/2018 at 9:00 am
Walk Begins: 10:00 am
Walk Ends: 1:00 pm

For more information, please contact:
Contact Name: Rick Robbins
Contact Phone: 434-828-4179
Contact Email: boss302rik@gmail.com

 

St. George – Out of the Darkness Walk

Walk Date: 09/29/2018
Walk Location: Highland Park – St. George, UT
Check-in/Registration Time: 09/29/2018 at 9:00 am
Walk Begins: 10:00 am
Walk Ends: 12:00 pm

For more information, please contact:
Contact Name: Theresa Bright
Contact Phone: 435-414-5957
Contact Email: lbush1942@gmail.com

 

General Information for Out of the Darkness Walks

Online registration closes at noon (local time) the Friday before the walk. However, anyone who would like to participate can register in person at the walk from the time check-in begins until the walk starts. Registration is free and open to the public. Walk donations are accepted until December 31st.

 

Hope 4 Utah – Walk 4 Hope

Walk Date: 09/29/2018
Walk Location: Timpanogos Elementary School – Provo, UT
Event Begins: 9:00 am

Find the latest information on their website and FB page.

 

What Do You Do at These Events?

The big thing is the walk, but it’s not the only thing going on at these events. There are plenty of booths and information. You can sample foodstuffs from local vendors. You can also pick out color beads to show your support for specific people and populations. This includes friends and family, servicemembers, and people who struggle with suicide ideation themselves. You can also check pick a color to support the cause in general.

Many of the people at these events come in groups, or teams, to remember someone in particular who has taken their life. Other people come only with their best friends or family to remember and be grateful that they escaped their own suicide attempt. You can find a quiet corner to contemplate your emotions, or you can find people—strangers or event staff—who are eager to talk to you…about almost anything.

 

 

What is the Walk and Fundraising Goal?

The walk is an easy 5k. In Salt Lake City, it’s two loops around Liberty Park. Nor is anybody going to judge you if you stop early. We had to do that one year, when we had to leave to go to work. Just remember to be careful where you step. Dogs are allowed on the walk, so you’re going to want to watch out for fresh piles of poo. We’ve learned this the hard way, too.

The Salt Lake City Out of the Darkness Walk is set to bring in nearly $250,000 for the cause. Adding the St. George and Vernal Walks, and the total is around $300,000. And this figure doesn’t count the resources marshalled at the Provo Walk 4 Hope event.

Individual fundraising can be set up as a standard pledge drive in which you ask friends, family, and coworkers to sponsor you, or people can make a flat donation to the organization. More than just raising money, the American Foundation for Suicide Prevention develops strategies for deploying these resources with the larger goal of reducing the annual suicide rate 20% by 2025.

Behavioral Health: What Does it Mean for Utah Residents?

Behavioral health is a characterization of how well a person thinks, feels, and acts to their environment. Desirable behaviors demonstrate an adaptability that tends to lead to a greater sense of well-being and life satisfaction. In Utah, however, the term is most often used for the collection of care services offered by the state’s mental health industry.

It’s no wonder that the term is difficult to define. Aside from the nuance of the human condition itself, it’s hard to find a label that fits all the different talk therapy, prescription medications, residential programs, and psychiatric hospitalizations that may be administered to people with dozens of different mental health diagnoses—diagnoses which are themselves quite varied.

 

The Professional Version of Mental Health

Behavioral health has been slowly but consistently replacing “mental health” among professionals in the industry. The terms mean the same thing and can be used interchangeably, but many professionals don’t like “mental health” because of its association with going mental and with the idea that psychological problems are “just in your head.” On the other hand, the new term is not universally loved by any means, even by the professionals.

Still, this preference can be most readily seen in the naming and branding of practices and provider sites. In the starkest example, Valley Mental Health decided to rebrand itself Valley Behavioral Health as part of a larger organizational change. Because so many mental health providers depend on organizational contracts and referral sources, this branding is often aimed at other health providers as much as the client base itself.

 

Behavioral Health vs. Psychiatric Services

On a similar note, in most hospitals today, what used to be the psychiatric wing or ward is now called the behavioral health unit. This, too, was seemingly done in response to the mental health stigma attached with “psychiatric ward.” On the other hand, psychiatric care has, arguably, come a long way over the years, decades, and even centuries since the worst practices were first introduced. Moreover, the industry as a whole has become more aware of and more proactive about fighting back against the stigmatizing effect of mental illness.

 

What this Change means for Utah Health Consumers

Arguably, behavioral health is an empowering way to cast mental health services. For one thing, it’s often easier to believe that one can change their behavior, rather than the underling mental illness. It’s certainly less stigmatizing than a lot of other options, too. The one thing it may overlook is the environment in which an individual lives. A big part of what mental health professionals do is make recommendations for changes to the residence or other environmental factors. At the very least, you hopefully won’t feel tripped up by the name and description of health services you receive from therapists, social workers, psychologists, and/or psychiatrists. Whether you’re looking for outpatient counseling and therapy services or inpatient treatment services, don’t hesitate to get the help from a clinic that speaks to your individual needs and priorities.

Learn about Behavioral Health Systems in Utah

Behavioral health systems are groups of mental health providers that offer complementary services streamlined through a single healthcare network. These networks are often anchored by one or more hospital care facilities, while also managing any number of outpatient treatment programs.

Keep in mind, however, that for a mental health screening or basic therapy services, accessing these networks may not be required. By working from a list of qualified therapists, psychologists, and physicians who accept your insurance plan or a private-pay arrangement, it’s usually possible to find first-line mental health services. (About half of licensed psychologists go into private practice, for example, rather than take a position with a healthcare institution.)

On the other hand, for someone with a serious mental illness, it can be helpful to understand how these health systems work and who the major players are in Utah:

 

Valley Behavioral Health

Formerly known as Valley Mental Health, this is one of the best examples of behavioral health systems in Utah in that it focuses solely on mental health services, while still managing more than a thousand different providers across numerous sites. As the primary Medicaid vendor for Salt Lake, Tooele, and Summit Counties—and one of the largest providers of mental health services in the state—efficiency is critical to the organization’s mission and its use of federal taxpayer dollars. It’s also been a source of controversy in recent years.

 

Behavioral Health and Integrated Care Networks

More often, behavioral health systems are one part of a larger healthcare network. This style of integrated care allows patients an easy way to access services within the network. There is greater efficiency within the system itself but less choice, especially for those whose insurance coverage is tied to a specific healthcare network.

Major healthcare network providers in Utah include:

  • Intermountain Healthcare
  • IASIS Healthcare
  • MountainStar Healthcare

To better understand how this all works, let’s consider a local example. With several healthcare facilities to manage, MountainStar designated Lakeview Hospital in Bountiful to be its go-to site for inpatient geriatric services. With this specialty designation, the hospital developed Senior Pathways, an innovative program of inpatient behavioral health care for seniors and the elderly. However, at another MountainStar site, Ogden Regional Medical Center, there is no behavioral health unit at all. Instead, this site focuses on a different set of specialized services.

 

Other Behavioral Health Systems in Utah

  • University of Utah Healthcare/Neuropsychiatric Institute: The University Neuropsychiatric Institute is on the cutting edge of behavioral health. Due to its high degree of specialization and advanced services, this single site receives referrals from surrounding states that, according to the Utah Hospital Association, encompass 10 percent of the continental United States. The institute is overseen by University of Utah Healthcare and the School of Medicine. The University of Utah also provides an opportunity to show how different behavioral health systems will sometimes partner together for specialized services and treatment programs. The Primary Children’s Hospital, for example, is part of Intermountain Healthcare but also serves as the pediatric teaching hospital for the university and, as such, the two organizations can more readily combine their resources.
  • Utah State Hospital: This hospital is run by the Utah Department of Human Services and the Division of Substance Abuse & Mental Health. A huge 350-bed facility with a large staff and resource support from the state government, this is a huge health site for forensic referrals and other individuals with serious mental illness.
  • Highland Ridge and Provo Canyon Behavioral Hospitals: As largely standalone sites, these struggle to fit the definition of a behavioral health system. Yet, as hospital care facilities dedicated solely to the delivery of mental health services, they offer a wide range of specialties that are comparable to many health network systems.

 

Personalized Plans for Severe Depression Treatment

Severe depression treatment is liable to include any number of different depression therapies and intervention strategies that can help the individual find some relief and build momentum toward a more positive mental health outcome. More than just severity rating, the entire course of the clinical depression should be taken into account when building a treatment plan. Just because symptoms are severe at the onset of the depressive episode doesn’t mean the individual won’t respond to less intrusive, first-line therapies. Likewise, substantially disruptive symptoms of depression that persist for a long period of time or which do not respond to common therapies may require their own tailored interventions.

As you consider what treatments might be relevant in your case, we suggest you keep in mind that treatment outcomes are rarely all good or all bad. Some people find immediate and nearly complete cessation of depression symptoms only to relapse in some number of weeks, months, or years. Other people may find more mild but consistent relief when receiving treatment. For some, there is little effect; for others, seeking treatment is truly a life-saver. With this in mind, here is an overview of the common types of severe depression treatment.

 

Psychotherapy

This is the catch-all phrase for the cognitive, behavioral, psychoanalytic, and client-centered or humanistic approaches that constitute talk therapy. This therapy may be administered by a wide range of mental health professionals, including mental health counselors, psychologists, psychiatrists, and licensed clinical social workers.

Given the right circumstances, even severe cases of depression may be treated with psychotherapy alone. On the other hand, with an aggressive combination of cognitive and behavioral therapies administered through an intensive psychotherapy program, this treatment bears little resemblance to the “in-and-out” office experience that many people associate with psychotherapy.

 

Antidepressant Medications

The jury is still out on how effective antidepressants are. Yet, certain types of severe depression offer some of the strongest evidence that these medications outperform placebos. In the state of Utah, you need to see a medical doctor—most likely a primary care physician or a psychiatrist—to get a prescription for antidepressant medications.

Some people go to see their doctor solely to get a prescription, but it’s just as important to get a physical examination that may identify a medical condition as the potential cause of the depression symptoms. Likewise, whether it’s a new or refilled prescription, it’s crucial that any side effects are closely monitored.

 

Depression Clinics and Specialized Protocols

Both short-term inpatient care and longer-stay residential treatment centers may be an appropriate outlet for severe depression treatment. It’s especially important to use these care facilities for anyone who poses a serious risk of harming themselves or someone else. Another common reason to seek out these clinics is the inability to perform essential tasks of daily living.

Electroconvulsive therapy and transcranial magnetic stimulation, on the other hand, are more common for persistent depression that does not respond to other forms of treatment. Results vary, but these treatments are often effective for approximately six month—while potentially impairing memory or creating other side effects.

 

Develop a Severe Depression Treatment Plan

Common for severe forms of depression, combination treatments are any strategy that uses more than one therapy in concert with one another. But again, it’s important to find one or more health providers who can first evaluate the symptoms and individual case history. Then, collaboratively, you and your health provider can develop a personalized treatment plan.

 

Learn about Mental Health Insurance Parity in Utah

In a broad sense, mental health insurance parity is the idea that financial coverage protections for mental health services should be the same as those for physical illnesses. Parity rules have changed a lot over the years since they’ve been first introduced, and they continue to evolve today. With this in mind, here is a brief historical context followed by information resources that will help you understand and access mental health insurance coverage in Utah.

 

A Short Timeline of Parity Laws in Utah

A groundswell of support for mental health insurance parity developed in the early 1990s and led to the passage of the first federal law, The Mental Health Parity Act, in 1996. Several states followed suit with their own parity legislation. In 2000, Utah joined the club by passing the Catastrophic Mental Health Insurance Coverage Act. Many of the definitions in this act have been revised over the years, however. The latest statute information can be found here.

Yet, these state laws were in general conflict with federal legislation passed in 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA). Originally scheduled to go into effect in 2010, these regulations have been postponed multiple times. Most recently, the Department of Health and Human Services issued the final rules in 2013.

 

Utah’s Record on Mental Health Insurance Parity

Overall, through the years, it’s been a mixed bag of policy and advocacy positions. Despite passing its own law, Utah has been behind many other states in the mental health parity protections offered to its insurance consumers. Specifically, the state allowed for a separate schedule of deductibles, co-pays, and co-insurance. The protections only applied to HMO and large group health plans. And the mandated option for mental health insurance only needed to provide 50% coverage.

Still, a lot of states offered comparable or even weaker protections. It’s also worth pointing out that, with one of the highest rates of serious mental illness in the country, Utah had a higher need but also a higher burden to implement these parity coverage rules. At the same time, Senator Orrin Hatch has been a leading advocate for mental health issues in the U.S. Senate and was instrumental in passing parity legislation.

Moreover, insurance isn’t the only kind of parity in the mental health world. Nor is it always a good thing. Utah also deserves credit for establishing mental health courts that seek to reduce parity with the regular criminal justice system and to instead identify outcomes that offer “therapeutic justice.”

 

More Resources for Mental Health Services in Utah

For information about the federal statutes contained in the most recent parity legislation, you can check out this resource from the U.S. Department of Labor.

If you’re interested in Utah’s current record for mental health services in general, you can take a look at Utah’s report card from the National Alliance on Mental Illness.

Looking forward, it will be interesting to see if mental health insurance parity expands access to mental health services in such a way that it puts added pressure on reforming Utah’s closed insurance panel system.

 

Things to Know about Inpatient Depression Treatment in Utah

Inpatient depression treatment is any therapy or combination of therapies that is delivered in a hospital setting for severe or treatment-resistant depression. Not all the hospitals in Utah have a dedicated behavioral health unit for this type of treatment, while others specialize in pediatric, adult, or geriatric populations. If possible, choosing a hospital with this specialization is preferred, but in an emergency situation, it’s best to seek immediate assistance. Know that severe depression may absolutely constitute a life-threatening emergency: For adolescents, suicide is the third leading cause of death, while 42 percent of inpatient services for adolescent mood disorders start with an emergency room visit.

 

Who Needs Inpatient Care Services?

Depending on the circumstances, inpatient depression treatment may be sought as a first-line defense or in response to treatment-resistant episodes. Given that each year approximately 5 million people experience a depressive episode but do not seek treatment, some people need inpatient care as a neglected episode deteriorates.

Inpatient care services may also be needed by those struggling with bipolar disorder. A comprehensive treatment plan should be developed to break the manic-depressive cycle, or at least help mitigate each stage. That said, inpatient care may be especially important during the transition from a manic to a depressive episode, as the rapid onset of depression is more common for individuals with a bipolar disorder.

 

When to Seek Inpatient Depression Treatment

  • An individual presents a risk of harming themselves or others. (If a mental health assessment determines someone poses a serious risk, they may be hospitalized involuntarily.
  • An individual is receiving a specific treatment requiring inpatient care—such as electroconvulsive therapy or continuous observation in connection with high-risk or experimental protocols.
  • An individual is unable to perform basic living activities or to care for themselves. This one is the hardest to pin down. It could be malnutrition, very poor hygiene, an inability to work, or extreme isolation and lack of social interaction.

 

What to Expect

A lot of people have questions about cost. The good news is that most health insurance plans now cover inpatient depression treatment. Moreover, due to recent changes in the law, many health insurance companies are in the process of revising their benefits and cost-sharing structure. It may also be helpful to contact your health insurer about different coverage rules for different hospitals.

Most often, the length of stay for these services is between 1-7 days. While getting feedback from both the patient and his or her close personal contacts, the hospital staff is the primary decision-maker in precisely how long inpatient care lasts. Yet, there are exceptions. For those who are compelled to receive inpatient care for a prolonged period of time, a judge must approve involuntarily treatment. And, in rare cases, insurance companies may also decide to suspend authorization for treatment.

 

How to Prepare for Your Stay

Many hospitals have similar rules about what you can and can’t bring with you. A change of clothes, some basic grooming items, and a few personal items that cannot be used to harm anyone is usually about it. To be as comfortable as possible and to avoid confusion, you may want to contact the hospital ahead of time for exact guidelines. But again, if an immediate intervention is needed, don’t hesitate to reach out to a local emergency room or one of the behavioral health units in Utah.

 

What Mental Health Parity Law Means for Access in Utah

Mental health parity law is the collection of federal and state statutes that seek to standardize mental health insurance benefits with those applied to physical illness. In the previous two decades in which these laws have been enacted, they’ve strengthened and clarified the insurance coverage offered to mental health consumers in Utah.

On the other hand, these same consumers are easily frustrated by rules that continue to evolve as various laws are implemented and as discrepancies between federal and state statutes are resolved. With this in mind, we’ve assembled a general guide for how mental health parity law impacts access to mental health services for state residents.

 

Parity Protections vs. Guaranteed Coverage

Perhaps the biggest misconception about the mental health parity law is that it guarantees mental health benefits are included in all health insurance plans. No such requirement exists, although a large majority of insurance plans do offer mental health benefits, including all plans sold through the health insurance exchange. Instead, new federal parity protections ensure that consumers won’t face a separate schedule of co-pays, co-insurance fees, and number of visits/days of care. What’s more, these protections now apply to small group and individual health insurance plans. An earlier version of the mental health parity law had already issued prohibitions against annual and lifetime caps that applied solely to mental health coverage.

 

Qualifying Mental Health Conditions

Just because an insurance plan covers mental health services doesn’t mean every condition qualifies. Utah state law defines a mental health condition as any illness “that falls under a diagnostic category listed in the Diagnostic and Statistical Manual,” with the following exceptions:

  1. Marital or family problem
  2. Social, occupational, religious, or other social maladjustment
  3. Conduct disorder
  4. Chronic adjustment disorder
  5. Psychosexual disorder
  6. Chronic organic brain syndrome
  7. Personality disorder
  8. Specific developmental disorder or learning disability
  9. Intellectual disability

 

Ongoing Changes to Mental Health Coverage

To get quotes for individual case fees and out-of-pocket costs, it may be necessary to contact specific mental health professionals as well as your insurance carrier. But more generally, research is a critical tool that allows health providers and insurance companies to determine what treatments should be deemed as medically necessary. After all, it’s one thing to say that mental health conditions should be covered the same way as physical conditions in terms of co-pays and office visits, but treatment services for major depression are quite different than those for a hip replacement. To this point, Medicaid and other insurance plans have only recently started providing coverage for autism.

 

Mental Health Parity Law and Consumer Access

Like so many things about health insurance, increased access usually happens behind the scenes where the group health plans are built by insurance companies and regulated by the Utah Insurance Department. Yet, increased coverage may not lead to increased access for consumers who do not know about the change. We encourage you to review your latest health plan information and to recognize that mental health services may not cost as much as out-of-pocket as you first believed.

 

Mental Health Insurance in Utah: What You Need to Know

Today, nearly all forms of mental health insurance are included within a general health insurance policy. There are a few options out there for supplemental mental health, but many of these stand-alone policies are largely designed for employers to get around the protections of the Mental Health Parity Act.

It’s important for individuals to understand the basics of mental health insurance in Utah. For one thing, financial coverage is an essential component of mental health access for most residents in the state. Likewise, it can be incredibly frustrating for individuals who believe they’ve found the ideal mental health provider only to discover the provider doesn’t accept the individual’s insurance coverage.

 

How People Get Mental Health Insurance in Utah

Exact figures are hard to come by, but there are easy ways to get a rough estimate. According to the latest health insurance figures from the Kaiser Commission on Medicaid and the Uninsured, 21 percent of Utah residents are covered by Medicare or Medicaid, both of which offer mental health coverage.

Moreover, 58 percent are covered through an employer group plan, while an additional 8 percent are covered by individual plans. How many of these plans included mental health benefits? According to a survey from the Society for Human Resource Management, “87 percent of organizations offered mental health coverage to their employees.” Individual health plans may have been less likely to include this coverage in the past. However, given that all plans sold through the health insurance exchange include this coverage, that’s no longer the case for many of these individuals.

Based on these figures, approximately 4 out of every 5 Utah residents have access to mental health insurance. Looking ahead, this coverage rate is bound to go even higher once the federal and state government resolve negotiations on the proposed Medicaid expansion. At Mountain Mental Health, we encourage to seek out general health insurance coverage and to look for new coverage programs and eligibility requirements that can expand your access to mental health coverage.

 

Insurance Benefits and Parity Protections

Just because an insurance plan includes mental health benefits doesn’t mean that every service is covered for an indefinite amount of time. The most commonly covered benefits include counseling and/or psychotherapy, prescription drugs, and short-term inpatient care—although there may be additional allowances for specific treatments. You should be able to determine the exact benefits by reviewing your coverage details or contacting the insurer directly. A mental health provider should also be able to tell you what types of insurance coverage they accept at their clinic.

If you do have mental health benefits, the coverage is likely to be stronger than ever thanks to new parity protections. You can read more about mental health parity rules in Utah here. But if you’re ready to seek out mental health services based on insurance coverage or as a private-pay arrangement, we can help you find a local, qualified mental health provider.

 

Utah’s Closed System for Mental Health Insurance Coverage

Utah is one of a few states that uses closed insurance panels for mental health insurance coverage and has a reputation for being one of the most closed systems in the country. Most consumers tend to think of insurance coverage as the various HMO and PPO networks that allow them to access certain health providers with a set cost structure.

But do you ever wonder how a mental health insurance professional—or even health provider—gets into one of these networks? They have to be invited! And with a closed insurance panel system, the insurance company may reject the invitation request based on any number of criteria and even when the health provider jumps through all the necessary hoops.

 

Closed Insurance Panels and Public Policy

The argument for and the argument against closed insurance panels are essentially the same: It allows insurance companies to more tightly monitor, regulate, and control the standard of care and costs associated with mental health insurance coverage. As such, insurance companies tend to point out that they strive to improve the affordability and quality of care. Increasing mental health access to Utah residents is the biggest part of our mission at MHAU, so we’re not going to pretend we’re not biased. But we’re not the only ones troubled by this model. Given that licensure is supposed to ensure the right to practice a given competency, the Utah Psychological Association is lobbying for stronger consideration of reform to this public policy.

 

Challenges for Mental Health Insurance Coverage in Utah

It’s one thing to guarantee at least a certain number of providers in a given competency area will be included in the network. Yet, the mental health clinics which offer services in the highest demand must frequently turn people away. This isn’t to suggest that insurance companies are to blame for all, or even most, of the cases involving underserved populations. There are a host of contributing factors that start with more rural and impoverished areas. This is on top of underlying state demographics, which show a rapidly growing population that, more than likely, also needs more mental health services per capita. And yet, it’s precisely because Utah is facing so many other challenges to access that it makes no sense to continue a closed panel system that increases barriers to access.

 

Related Insurance Issues

You can find information about Utah’s closed insurance panels through the Department of Administrative Services. This information is most often relevant for those who are looking into the Rules for the Coordination of Benefits.

 

A Big Deal for Individual Access

To this point, it’s not just the day-to-day access that potentially suffers through closed insurance panels. The policy also creates disincentives for mental health providers to ask for and be persistent about getting an invitation to panels that will allow them to better serve client populations.

Here are a few scenarios that demonstrate specific areas of concern:

  • Someone with a serious mental health issue makes the effort to contact a provider within the insurance network. This first provider has a full schedule and provides a referral to another provider that’s difficult to access geographically. Instead of getting help, the individual gets discouraged and ignores crucial mental health needs.
  • Someone who depends on mental health insurance coverage is struggling with a mental illness. They’ve just developed a strong therapeutic relationship with a mental health professional, but a major life change in the family requires a switch to different coverage and—even though the provider is willing to go through the 3-4 month process necessary to expand their practice’s insurance referral sources—the panel is closed. The individual feels compelled to look for access elsewhere, but the mental health outcome isn’t as positive.

 

Three Ways to Take Action

  1. Get Help First. If you or someone you know is trying to get help, don’t let an initial setback stop you. Don’t let a lack of access to a single provider serve as an excuse that prevents you from getting help altogether.
  2. Share a Story. If you’ve been part of a situation that demonstrates why closed insurance panels do or do not work, tell us the story.
  3. Lend Your Voice. Contact the Utah Insurance Department to express your opposition to this policy, or if you have a personal grievance about the services provided by your insurance company, you can file a complaint.