The report reviewed barriers and gaps in insurance coverage for mental health and substance use services prior to the Affordable Care Act (ACA). The report found that, prior to the ACA:

  • 28 states had no requirement that individual market health insurance plans cover or even offer mental health services;
  • Health plans avoided enrolling individuals with mental health or substance use conditions by screening applicants;
  • Even when individual market insurance was accessible, insurers effectively fined people with a history of mental health or substance use conditions by applying a 20–50% increase in premiums while also excluding needed mental health and substance use services; and
  • Plans often used lifetime caps, limits on outpatient visits, limits on inpatient days covered, restricted access to mental health medications and high cost-sharing for mental health services.

While the Affordable Care Act (ACA) made mental health and substance use services an essential health benefit (EHB), there are new threats that would weaken protections in insurance coverage and hurt people with mental illness.

NAMI released a report, Mental Health Parity at Risk. The report, written by researchers at Georgetown University, highlights how badly health insurance plans treated people with mental illness before the Affordable Care Act (ACA). For the first time, comprehensive data has been gathered showing barriers and gaps in mental health and substance use coverage in the individual insurance market prior to the ACA. It highlights just how horrible things were for people with mental illness, and emphasizes the dangers of turning back the clock. You can learn more and read the report at

To discuss this report as well as other challenges we are facing, NAMI participated in a live event at Washington Post this morning. The event, Mental Health and Well-being in America, featured policymakers including Sens. Schatz and Tillis, health care experts including Dr. Josh Gordon, and others. To view this event, you can access it at

ACT NOW: Opioid Legislation Moving

Next week, the House will consider multiple pieces of legislation to address the opioid epidemic, and many of these bills will improve mental health and substance use care.

Representatives will consider legislation that will:

  • Make it easier for people who have Medicare to access telemedicine for mental health and substance use care (Access to Telehealth Services for Opioid Use Disorders Act – H.R. 5603);
  • Require the Children’s Health Insurance Program (CHIP) cover mental health and substance use conditions (CHIP Mental Health Parity Act – H.R. 3192); and
  • Allow people using Medicare Part D to get prior authorization electronically from their health care providers for needed medications (PASS Act of 2018 – H.R. 5773).

The House will also vote on a bill that will treat health information fairly across all conditions, improving outcomes for people with mental illness and substance use disorders. An outdated federal regulation known as 42 CFR Part 2 keeps health care providers from accessing information about a person’s substance use condition history, which may lead to inappropriately prescribing opioid medications or inadvertently triggering substance use relapse—and in some cases, leading to harmful health consequences and even drug overdose deaths.

H.R. 5795, the Protect the Confidentiality of Substance Use Disorder Patient Records Act, will align 42 CFR Part 2 with Health Insurance Portability and Accountability Act (HIPAA) regulations. This will allow for better integration and coordination of treatment—and better outcomes for people with mental health and substance use conditions.

Act now.  Ask your Representative to support these bills to address the opioid crisis and provide improved care for all people with mental health and substance use conditions.

Parkland Tragedy

NAMI, the National Alliance on Mental Illness, is deeply saddened by the tragic school shooting that occurred in Parkland, Florida. These tragedies impact our communities –our parents, our children, our school professionals, our first responders –the mental health of our whole country.

The details are still unfolding and there are still unanswered questions, but what we do know is that there were warning signs and that the shooter had received mental health treatment. As we continue the national discussion about what we can do to prevent further tragedies, we need to be willing to engage in an honest conversation about what allowed this young man to fall through the cracks, and the broader personal and societal factors that may have fueled his actions.

It is paramount for us to ensure the safety and wellbeing of our children and youth, and to remember that 1 in 5 people, potentially hundreds of students in a high school, have or will experience a mental illness. We need to be very careful that the response to these tragedies by the media and others does not discourage students from seeking help.

There are steps we can take now to educate and intervene early to break down barriers of understanding, and put an end to the stigma that often prevents people from getting the help they so desperately need:

1. Increase mental health awareness and availability of counselors in schools. Students should be encouraged to seek help for themselves or a friend. School  based mental health has also proven extremely effective in engaging students who would not otherwise seek help. Some states have made significant investments in school based mental health and more needs to be done

2. Train school staff, administrators, parents and youth, and provide the tools necessary to have conversations about the signs and symptoms of mental health conditions and where they can turn to for help. Far too often, when families are most in need, there isn’t a clear pathway to getting help.

3. Develop a comprehensive response program for youth who have demonstrated behavioral issues including involving family and mental health providers. Take steps to avoid expelling and suspending students as this only exacerbates the situation.

4. Increase the ability of the mental health system to be proactive in reaching out to youth, particularly those with the most serious conditions. Young people in distress will not seek help so there need to be mobile outreach responses that are funded and easily available. This requires sustained and expanded funding for coverage for mental health, not cuts.

Another part of the conversation that cannot be ignored is acting on common sense approaches to ending gun violence such as gun violence prevention restraining orders, which can allow for the removal of guns from people who may pose a risk of violence to themselves and others. While the relationship between mental illness and gun violence is very low, we need reasonable options, including making it
possible for law enforcement to act on credible community and family concerns in circumstances where people are at high-risk.

We all want an end to these horrific acts of violence.To achieve this, we need to understand the full picture of what is really driving increased violence and take sensible steps. Only then can we find meaningful solutions to protecting our children and communities.About NAMI NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

We support efforts to make mental health treatments and services available to all Floridians, including supportive housing and employment. We also strongly encourage the Legislature to invest in efforts that increase public awareness around the signs and symptoms of mental illness and ways that Floridians can find help.