Make therapy free for everyone

The COVID-19 pandemic has helped draw more attention to mental health issues that can be overlooked in public policy discussions. Even as the worst of the pandemic recedes, this is a good moment to consider improvements in mental health policy, especially better screening for mental illness; true equivalence between mental and physical health; Providing cognitive-behavioral therapy (CBT) to all for free.

  1. Better mental health check up

Mental health problems typically appear early in life, with three-quarters of lifelong mental health cases beginning to occur by age 24. However, an average of 11 years elapse between the onset of symptoms and diagnosis. Early detection allows for earlier and more effective treatment. Screening for depression and substance use disorders has the necessary approval from the United States Preventive Services Task Force and must be covered (often without cost sharing) under private insurance plans, Medicare and most Medicaid coverage, largely due to the provisions of the Affordable Care Act. But often it is not provided. Mental health screenings should now be universal in schools and colleges, as well as in all clinical settings, including those serving pregnant women and new mothers.

  1. The true equivalence between mental and physical health

Additionally, while applicable laws require that insurance plans cover mental and physical health care equally, this is not always the case in practice—in part because the legal framework has significant loopholes. A good place to start would be to implement the recommendations of the Equivalency Task Force on Mental Health and Substance Use Disorders in 2016, particularly leveling the field in terms of prior licensing requirements, introducing equivalence “molds” to insurance companies, and imposing fines for equivalence violations. All employer plans must also be legally required to cover mental health care.

  1. Free comprehensive cognitive behavioral therapy (CBT)

When it comes to providing mental health treatment, a simple step in the right direction is to enable universal access to cognitive behavioral therapy (CBT). Cognitive-behavioral therapy is an “experience-based, problem-focused psychological treatment that teaches patients to detect and modify thought patterns and change behavior to reduce distress and promote well-being.” It has proven to be very effective and relatively inexpensive. One study in the UK even concluded that the financial benefits for higher employers and lower disability claims would outweigh the direct financial costs of free universal savings.

The UK has now introduced free access to treatment without referral through the National Health Service. The US Army is now providing psychological support to soldiers to promote “mental fitness”. As Brigadier General Rhonda Cornum, Director of the Comprehensive Soldier Fitness Program, said, “We need to take care of psychological fitness the same way we do physical performance.” This is true for everyone. Comprehensive coverage will also send a signal that mental health problems of one kind or another are the norm rather than the exception, which can help reduce stigma.

In the US, providing universal access to treatment would be more complex than in the UK, but it could still be achieved through improvements such as:

CBT is relatively cheap and very effective. Of course, there are other forms of treatment that are equally effective in certain situations – drug-assisted therapy (MAT) for substance use disorders, for example – and these treatments should also be freely available. The argument for CBT in particular has been made here because of its broad effectiveness and low cost; But it should simply be seen as an example of the kind of reforms needed to scale up mental health care more broadly.

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