The current and future state of mental health insurance parity legislation

The stigma of childhood mental disorders: a conceptual framework

OBJECTIVE

To describe the state of the literature on stigma associated with children's mental disorders and highlight gaps in empirical work.

METHOD

We reviewed child mental illness stigma articles in (English only) peer-reviewed journals available through Medline and PsychInfo. We augmented these with adult-oriented stigma articles that focus on theory and measurement. A total of 145 articles in PsychInfo and 77 articles in MEDLINE met search criteria. The review process involved identifying and appraising literature convergence on the definition of critical dimensions of stigma, antecedents, and outcomes reported in empirical studies.

RESULTS

We found concurrence on three dimensions of stigma (negative stereotypes, devaluation, and discrimination), two contexts of stigma (self, general public), and two targets of stigma (self/individual, family). Theory and empirics on institutional and self-stigma in child populations were sparse. Literature reports few theoretic frameworks and conceptualizations of child mental illness stigma. One model of help seeking (the FINIS) explicitly acknowledges the role of stigma in children's access and use of mental health services.

CONCLUSIONS

Compared with adults, children are subject to unique stigmatizing contexts that have not been adequately studied. The field needs conceptual frameworks that get closer to stigma experiences that are causally linked to how parents/caregivers cope with children's emotional and behavioral problems, such as seeking professional help. To further research in child mental illness, we suggest an approach to adapting current theoretical frameworks and operationalizing stigma, highlighting three dimensions of stigma, three contexts of stigma (including institutions), and three targets of stigma (self/child, family, and services).

A comparative analysis of mandated benefit laws, 1949-2002

OBJECTIVE

To understand and compare the trends in mandated benefits laws in the United States.

DATA SOURCES/STUDY SETTING

Mandated benefit laws enacted in 50 states and the District of Columbia for the period 1949-2002 were compiled from multiple published compendia.

STUDY DESIGN

Laws that require private insurers and health plans to cover particular services, types of diseases, or care by specific providers in 50 states and the District of Columbia are compared for the period 1949-2002. Legislation is compared by year, by average and total frequency, by state, by type (provider, health care service, or preventive), and according to whether it requires coverage or an offer of coverage.

DATA COLLECTION/EXTRACTION METHOD

Data from published tables were entered into a spreadsheet and analyzed using statistical software.

PRINCIPAL FINDINGS

A total of 1,471 laws mandated coverage for 76 types of providers and services. The most common type of mandated coverage is for specific health care services (670 laws for 34 different services), followed by laws for services offered by specific professionals and other providers (507 mandated benefits laws for 25 types of providers), and coverage for specific preventive services (295 laws for 17 benefits). On average, a mandated benefit law has been adopted or significantly revised by 19 states, and each state has approximately 29 mandates. Only two benefits (minimum maternity stay and breast reconstruction) are mandated in all 51 jurisdictions and these were also federally mandated benefits. The mean number of total mandated benefit laws adopted or significantly revised per year was 17 per year in the 1970s, 36 per year in the 1980s, 59 per year in the 1990s, and 76 per year between 2000 and 2002. Since 1990, mandate adoption increased substantially, with around 55 percent of all mandated benefit laws enacted between 1990 and 2002.

CONCLUSIONS

There was a large increase in the number of mandated benefits laws during the managed care "backlash" of the 1990s. Many states now use mandated benefits to prescribe not only what services and benefits would be provided but how, where, and when services will be provided.

Is psychiatric research stigmatized? An experimental survey of the public

Although decisional incapacity can be caused by various medical conditions, incapacity due to mental illness is often singled out for scrutiny in research ethics policy debates. We assessed whether there is a general discriminatory perception of mental illness research and, if so, aimed to characterize the nature of that perception. We conducted an experimental, randomized Internet survey of the general public. We recruited 3140 adults through a web-research survey panel, with oversampling of racial and ethnic minorities and the elderly. Willingness to allow medical versus mental illness research was compared by randomly assigning the respondents to 1 of 7 web-based experimental scenarios depicting a subject being considered for research participation. Respondents were more willing to allow research with medically ill than the mentally ill subjects, even when ethically relevant factors were equal. This difference was mediated through the respondents' tendency to view mentally ill subjects as more decisionally incapable than medically ill subjects, even when they were told that the subjects portrayed were in fact competent. Discriminatory perception of mental illness research exists and is mediated by an outdated view of mental illness and decisional capacity. Policymakers and institutional review board members may need to guard against its influence in their deliberations.