Caring for children with mental disorders: do state parity laws increase access to treatment?

BACKGROUND: High prevalence rates of mental health disorders in childhood have garnered increased public attention in recent years. Yet, among children diagnosed with serious mental health problems, a majority receive no treatment. Improving access to mental health services for children with behavioral and emotional disorders constitutes an important policy concern. AIMS OF THE STUDY: To study whether living in a state that has implemented a mental health parity law affects a child's use of outpatient mental health services.
METHODS: We use the National Survey of America's Families (NSAF) 1997 to 2002 to study whether enacting a state parity law increases the probability that a privately insured child receives mental health treatment (N=26,916). Using a differences-in-differences model, we control for detailed information on a child's health and functioning, and compare mental health care use before and after state parity implementation with non-parity states serving as a comparison group.
RESULTS: Regression results indicate that state parity laws do not affect the likelihood of a child receiving outpatient mental health services. Among the subset of children identified with a greater need for mental health care, the effect of parity appears to be somewhat larger in magnitude but remains insignificant. DISCUSSION: State mental health parity policies aim to improve equity in private insurance coverage for mental health care and could provide a mechanism for reducing unmet need among children with mental health care disorders. Yet, our results suggest these policies do little to affect rates of use. IMPLICATIONS FOR HEALTH CARE PROVISION AND UTILIZATION: Parity policies do not appear to represent a sufficient strategy for addressing access to mental health care among children and adolescents. IMPLICATIONS FOR HEALTH POLICIES: Developing new approaches to encourage the receipt of high value mental health care in youth constitutes a persisting challenge under both public and private insurance arrangements. IMPLICATIONS FOR FURTHER RESEARCH: Since other research has shown that state parity laws are helpful in reducing the family financial burden of caring for a mentally ill child and do not drive up total health care costs, these policies serve a vital function. However, given persistent access problems in the child population, research aimed at increasing rates of mental health services use is needed. In addition, future research on parity laws should consider whether, conditional on having a visit, children in parity states are likely to have more visits compared with other children.