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David Baxter PhD

Late Founder
New law makes room for more talk therapy
September 16, 2007

The News & Observer, Raleigh, N.C. -- A North Carolina law that takes effect in July will require private health insurers to cover bipolar disorder and eight other mental illnesses at the same level as physical illnesses.

The new mental health parity law requires insurers to cover at least 30 mental health office visits and 30 inpatient or outpatient hospital days. Today, if coverage for mental health services exists at all, it is typically limited to a handful of office visits and hospital days.

The limited coverage is one reason a typical treatment plan for a person with mental illness has focused mainly on medication therapy, even though many psychiatrists and other professionals who see patients with mental illness agree that a combination of drugs and talk therapy is most effective.

But the insurance model was based on a simple equation. Pills are quick, prescribed in a single office visit. Talk therapy is slow, often taking months or even years before a patient feels better.

A study published this month on the diagnosis and treatment of bipolar disorder in children found that just four out of 10 children received talk therapy. Most took a combination of two or more drugs.

John Tote, executive director of the Mental Health Association in North Carolina, a statewide advocacy group, said the new parity law should make it possible for more patients to see someone for longer-term talk therapy.

"Adults and children should be able to take advantage of those 30 visits long before any utilization management or case management or other limiting factors come into play," he said. "You're talking about more than two visits a month. It's a tremendous improvement."

The new parity law might have a downside for those concerned that bipolar disorder is being diagnosed too readily, especially in children. Now that insurance coverage for broader treatment is available, clinicians might be more inclined to describe a troubled patient as bipolar even if they suspect a different diagnosis would be more accurate.

"If you describe it one way and there will be [insurance coverage], and if you describe it another way and there won't, it's going to create a huge pressure to describe it as something there is coverage for," said Eric Youngstrom, a UNC-Chapel Hill child psychologist who specializes in bipolar disorder.
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