- Understanding the impact of behavioral health.
- Behavioral health counseling and treatment.
- Mental health vs. behavioral health: What’s the difference?
- Common symptoms of an underlying mental health or behavioral health issue.
- Behavioral health and insurance: What is covered?
- Checking an insurance plan’s benefits.
- Mental illness impacts millions of American lives; however, many live without knowing that they can receive treatment or care for their conditions.
- Behavioral health is a vast field, meaning forms of treatment or behavioral health care can look different for each patient depending on what they need help with.
- It’s common for the term “behavioral health” and “mental health” to be used interchangeably despite their distinct differences.
- When thinking about behavioral health in terms of insurance, it can be challenging to understand what is covered.
Behavioral health services focus on daily habits, behaviors, and actions that can be impacting a patient’s mental and/or physical health. For example, when examining the behavioral health needs of a patient, a behavioral health provider may look at the patient’s daily exercise or eating habits to see how they are linked to their levels of anxiety or depression. Many in the medical field view behavioral healthcare as more holistic, calling it “better care and health for the whole person.”
Understanding the impact of behavioral health.
Recent studies have shown that over 44 million Americans are currently suffering from mental illness; however, only 43% are actively receiving care. In the same vein, almost 20 million Americans suffer from substance abuse disorders; meanwhile, only 11% are receiving care. To put that into perspective, 44 million suffering from a mental illness is greater than the entire population of California; 20 million suffering from substance abuse disorders is equivalent to the entire population of Florida. Furthermore, when looking at those Americans, “Up to one-third of adults potentially meet the criteria for a past year behavioral health disorder,” with “half report[ing] that their disorders were first experienced by age 14, and almost three-quarters report[ing] that their disorders were first experienced by age 24.” Behavioral healthcare affects people across the nation, with ages ranging from an infant to an older adult 55 and up. Studies show that 20% of people over the age of 55 suffer from a mental disorder, with two-thirds of nursing home residents exhibiting behavioral health problems. However, only 3% of those reported adults are actively seeing a mental health professional for their symptoms and disorders. This shows that the disorders the behavioral health field handles touch the lives of many, yet the majority affected don’t recognize they are suffering or know that they have access to care.
Behavioral health counseling and treatment.
When looking into treatment for a behavioral disorder, a patient will find that a behavioral health professional and their services are more common than believed. For example, a social worker, counselor, psychiatric nurse practitioner, neurologist, and even a primary care provider are all linked to and trained to administer forms of treatment for a behavioral disorder. Furthermore, treatment programs can be facilitated in numerous ways depending on the behavioral health issue or mental disorder the patient may have e.g. inpatient programs, outpatient programs, specialized rehabilitation programs, therapeutic programs such as cognitive behavioral therapy, etc.
Once the client picks their trusted behavioral health consultant, their first behavioral health consultation may consist of the doctor examining or asking questions to the patient about a wide range of “behaviors” and prior medical history. For example, it is common to assess if the patient is struggling with a present or past substance abuse disorder, a relationship with gambling or other addictive behaviors, their life at school or at home, their history of trauma, or struggle with a past health condition, different components of their mental health including past diagnoses of a mental health issue, their relationship with food or exercise in case of the presence of an eating disorder, etc. Fundamentally, behavioral health requires a vast look into a patient’s background because their daily routine involves a variety of components that can have a significant effect on their mental and/or physical health. Symptoms are often complexly interconnected and vary from patient to patient.
Mental health vs. behavioral health: What’s the difference?
The primary distinction is that behavioral health is often viewed as a “blanket term” that includes mental health because it examines how a person’s daily actions can affect their mental state. However, overall mental health and mental issues can also stand alone, meaning they can be the root cause of certain habits and actions a patient is doing daily. For example, when a patient has a history with a mood disorder or is diagnosed to have bipolar disorder, panic disorder, generalized anxiety disorder, or another mental health disorder, it is common for their illness to cause a behavioral health condition i.e. comorbidities are common with a mental health condition. On the flip side, it is common for routine behaviors and activities to induce certain anxiety disorders or heighten issues like depression or stress as well. Essentially, when thinking about the differences between mental health and behavioral health, it’s important to note how interconnected they are; our behaviors can influence our minds, and our minds can influence our actions or behaviors. This shows that behavioral health/behavioral health treatments and mental health/mental health services are connected but different, depending on which is affecting the other.
Common symptoms of an underlying mental health or behavioral health issue.
Common symptoms of a potential mental health issue or behavioral health issue include but are not limited to:
- Feeling sadness or overwhelming depression.
- Exhibiting a reduced ability to concentrate.
- Worrying excessively or experiencing unnecessary fears.
- Exhibiting extreme mood swings or emotional changes.
- Withdrawal from activities, friendships, and other social gatherings.
- Significant changes in eating habits.
- Suicidal thoughts or active thinking about harming yourself or others.
- Signs of dementia or lack of intellectual ability (especially those over the age of 55).
- Substance abuse.
Increased levels of stress, fear, and distress can be linked to behavioral health issues through the influence of the immune and cardiac functions of the body. If any/all of these signs or symptoms are actively present, seek the guidance of a primary care provider, behavioral health counselor, or mental health professional.
Behavioral health and insurance: What is covered?
What many people don’t know is that in 2008 the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was created, often called the “mental health parity law” or the “federal parity law.” The American Psychological Association stated that this law “requires insurance companies to treat mental health and behavioral health and substance use disorder coverage equal to (or better than) medical/surgical coverage.” Two big areas of insurance that were affected were co-pays and visit limitations. One example of this is, if an insurance company only requires a $20 co-pay for most medical visits then they must issue the same co-pay for a mental/behavioral health visit. In regards to visit limitations, it used to be common for insurance companies to place a limit on the number of mental health visits a client could have in a year; however, this is no longer allowed.
Despite this law, there are still a few setbacks, such as:
- Insurance companies can still place a “medical necessity” limit on mental health, behavioral health, and substance disorder visitations.
- Psychologists and other behavioral service providers have the discretion over which insurance plans they accept.
- The parity law does not require insurers to provide behavioral health benefits; it just requires that if they do, they can’t have more restrictive requirements than physical/medical health benefits.
However, when looking at insurance plans, the parity law does actively affect:
- Employer-sponsored health coverage for companies with 50 or more employees.
- Coverage purchased through health insurance exchanges that were created under the healthcare reform law, also known as the Affordable Care Act or “Obamacare.”
- Children’s Health Insurance Program (CHIP).
- Most Medicaid programs.
When looking at health insurance coverage, it’s essential to check the plan’s benefits description to ensure behavioral health, mental health, and substance disorder visitations are covered. If it’s unclear, speak directly to the insurance company for more details.
Checking an insurance plan’s benefits.
When struggling to figure out what an insurance plan covers regarding doctors, clinics, prescriptions, etc. be sure to log onto the insurance company’s online platform and check the “Summary of Benefits and Coverage” section, often called an “SBC.” It is required for all insurance companies to have this document, which outlines all of the services and benefits it provides. If it’s still unclear, contact the company directly via phone or email to get more information.
Tip: Due to the parity law mentioned in the section above, most health insurance plans, including Medicaid and Medicare, offer coverage for behavioral health care or mental health care. To learn more about behavioral healthcare coverage under Medicaid or Medicare insurance, visit this source.
The holidays are meant to be fun and festive: marked by delicious and hearty meals, good cheer and most of all, family and friends. If there’s any time of year when clans big or small reunite, it’s during the holiday season. While family reunions are cause alone for celebration, it’s important to keep safety and health in mind, especially when it comes to older adults.