Disabilities and Mental Health (HP9)

Table of Contents

TOC o “1-3” h z u HYPERLINK l “_Toc325788766” Introduction PAGEREF _Toc325788766 h 3

HYPERLINK l “_Toc325788767” Discussion PAGEREF _Toc325788767 h 3

HYPERLINK l “_Toc325788768” Barriers to health care for people with disabilities and mental health disorders PAGEREF _Toc325788768 h 3

HYPERLINK l “_Toc325788769” Mental health: The minority and the uninsured PAGEREF _Toc325788769 h 4

HYPERLINK l “_Toc325788770” The Americans with Disabilities Act PAGEREF _Toc325788770 h 5

HYPERLINK l “_Toc325788771” Impact of the ADA PAGEREF _Toc325788771 h 5

HYPERLINK l “_Toc325788772” The Mental Health Parity Act PAGEREF _Toc325788772 h 7

HYPERLINK l “_Toc325788773” Impact of the MHPA PAGEREF _Toc325788773 h 7

HYPERLINK l “_Toc325788774” Summary PAGEREF _Toc325788774 h 8

HYPERLINK l “_Toc325788775” References PAGEREF _Toc325788775 h 9

IntroductionDisability is an umbrella term that is used to refer to impairments, restrictions to certain participations and limitations to some activities. The individual with a particular health condition will have some difficulty as they interact with factors existing around them including personal and environmental factors. Approximately more than one billion people are living with some form of disability. In addition, there is a rising trend in the rates of disability partly because of the aging populations as well as the growing chronic health conditions. All people living with a disability require the same general health care needs as the other people in addition to the health care needs they have resulting from their individual conditions. Individuals with disabilities are reported to seek more health care compared to those that do not have a disability. An example is a recent survey focusing on individuals with serious mental disorders that found more than 30% of people in developed countries and more than 70% in developing countries had received zero treatment in the year before the study. This paper will address the health policy issues relating to disabilities and mental health.

DiscussionBarriers to health care for people with disabilities and mental health disordersThere are a number of barriers that people with disabilities have to overcome in order to access health care. These barriers include high costs, limited availability of services and some physical challenges. The costs arise in transportation and affordability hence two reasons that create challenges to people with disabilities when accessing health services. In low-income countries, approximately 32% of non-disabled persons are not able to afford health care whereas those with disabilities that are not able to afford health care are approximately 52%. People with disabilities have to overcome the lack of appropriate services in health care (Crowley, 2006a). Lack of services is a very significant issue that is addressed in the Americans with Disabilities Act (ADA). Physical barriers include uneven access to various building and rooms in the institutions, inadequate washroom facilities, inaccessible parking areas, and medical equipment that are not easily accessible. An example is the limited access to breast and cervical cancer screening for women that have mobility difficulties since the examination tables as well as the mammography equipment only accommodate women who can stand (they are not height-adjustable) (Crowley, 2006b). People with disabilities experience the problem of inadequate skills in health care providers. They are twice likely to consider the skills of a health care provider to be inadequate to address their needs and four times more likely to report that a health care provider treated them badly. In addition, they are three times more likely to present a complaint of denial of care.

Mental health: The minority and the uninsured

Mental illnesses are severe and disabling orders that affect all populations irrespective of the ethnicity or race. Effective treatments have been embraced over time but disparities continue to affect people with mental disorders including limited availability of health services, lack of access to health services and low quality of treatment for ethnic as well as racial minorities (Mental Health America, 2011a). The disability burden on the ethnic and racial minorities therefore tends to be higher. The uninsured people with disabilities and mental disorders continue to find health care services highly costly and unaffordable. Another disparity experienced by the ethnic and racial minorities is the limited information available regarding mental health needs since few studies get to be carried out based on this area.

An estimate of 43 million Americans has zero health insurance (Mental Health America, 2011b). Federal and state parity laws continue to address this issue by for instance equalizing mental health benefits in insurance programs for the public. However, the many people who have no private insurance and are unemployed continue to find access to health services unaffordable since they don’t get public benefits and they have no private insurance to pay for their health care costs.

The Americans with Disabilities Act

The Americans with Disabilities Act (ADA) is a federal civil-rights statute that aims to protect the rights of those people with disabilities. The impacts of the ADA are felt on access to employment, access to state as well local government programs and access to public services such as transportation among other things (National Conference of State Legislatures, 2011a). It has a very broad scope in addressing the various factors that bar the participation of disabled persons. The Act’s civil rights are similar to the ones that have been developed in the past by the federal government purposing to address a number of issues regarding women, ethnic, racial and also religious minorities. Equal opportunity is the priority in the ADA therefore most provisions prohibit discrimination and provide for the equality of all Americans in the pursuit of employment, products, services as well as other opportunities.

Impact of the ADA

The ADA is projected to create equality for people with disability where they are able to participate in the society in as much capacity as those that are not disabled. In the event that the Act is implemented appropriately, people with disability get equal consideration in employment. It is important to understand that although ADA prohibits employers from discriminating disabled persons, it does not extend to the provision for accessible housing, job training, and such services (Amado et al, 2002a). Many people are yet to understand some major provisions of the ADA including that of employment. The Act only advocates for some services such as accessible transportation to be made available but it does not provide transportation for the people living with disabilities. The impacts of the ADA are yet to be felt fully as its implementation is reported by Americans with disabilities to be partial. Most remain frustrated that discrimination still exists although ADA has already been implemented. The barriers they face are primarily based on attitude and there is also the additional issue of growing backlash opposing the rights of people with disabilities as well as ADA.

Another impact of the ADA is the increased access to education, accommodations in the workplace and transport for people with disabilities. Following the various provisions of the ADA more opportunities have been created for them to pursue their interests compared to before the ADA was passed (Mental Health America, 2012). Resulting from the greater access, a passive increase in community participation has been reported. Active increase in participation has also been identified in a number of scenarios due to the increased efforts of employers, businesses, and also governments in reaching out to disabled persons and encouraging them to participate.

Options for independent living have become better for persons living with disabilities especially after the ‘Olmstead v.I.C.’ decision taken by the Supreme Court requiring community integration (National Conference of State Legislatures, 2011b). The process of attaining the goals of independent living is however being slowed down by outdated government restrictions, some medical attitudes and other such factors. The goal of ADA that has had limited impact on the lives of persons with disabilities is economic self-sufficiency. Although there is a considerable number of Americans with disabilities that has experienced improved quality of life, there are those that remain disenfranchised.

The Mental Health Parity Act

The Mental Health Parity Act (MHPA) is applied to those organizations that have 51 employees or more. According to the Act, the employers of such companies are required to provide coverage regarding the diagnosis as well as the necessary medical treatment for mental disorders (American Psychiatric Association, 2012). The terms and conditions applied here are similar to those applied to other medical conditions. Major provisions include the requirement to provide lifetime and annual maximums that are not discriminatory for medical as well as mental health benefits (Amado et al, 2002b). Also, a health plan is restricted from imposing dollar limits on hospital stays together with outpatient visits but it is legal to impose day limits on the same. Substance abuse and chemical dependency are excluded by the Act from equal maximums requirement.

Impact of the MHPA

The implementation of the MHPA was initially hindered by efforts of insurers and employers to circumvent its legislations. A particular strategy that insurers used was larger emphasis on cost sharing whereby they raised co-pays, deductibles, and also out-of-pocket maximums. There were also impositions of limits on the number of days in a hospital visit as well as the number of visits with a health care provider. The MHPA has had significant impact on the fight against insurance discrimination towards people seeking mental health treatment and also treatment of substance use disorders. Following the implementation of the Act, equal insurance coverage for both mental and physical health has increased (Amado et al, 2002c). The Act preserves the current state laws on parity and consumer protection while at the same time extending protection of services for mental health to more than 80 million Americans who are not protected by state laws.

SummaryPeople with disability experience a number of challenges in the access of health care services. This is especially worse in those that are uninsured and the minority. The Americans with Disabilities is a legislation that was enacted to address issues relating to the health of persons with disabilities and mental health disorders. The various legislations addressing people with disabilities purpose to improve their quality of life provide equal opportunities for them enhance their economic self-sufficiency and increase their participation.

ReferencesAmado L. N., Rice P. D. and Wunderslich G. S. (2002). The Dynamics Of Disability: Measuring And Monitoring Disability For Social Security Programs. The National Academic Press. Retrieved May 25, 2012 from HYPERLINK “http://www.nap.edu/openbook.php?isbn=0309084199″http://www.nap.edu/openbook.php?isbn=0309084199

Crowley, S. J (2006). Access to health and long-term services for people with disabilities. Kaiser Family Foundation. Retrieved May 25, 2012 from HYPERLINK “http://www.kaiseredu.org/tutorials/Disabilities/disabilitiescare.html”http://www.kaiseredu.org/tutorials/Disabilities/disabilitiescare.html

Mental health information. Mental Health America. 2012. Retrieved May 25, 2012 from HYPERLINK “http://www.mentalhealthamerica.net/”http://www.mentalhealthamerica.net/

Mental health: The minority and the uninsured. Mental Health America. 2011. Retrieved May 25, 2012 from HYPERLINK “http://www.nmha.org/”http://www.nmha.org/

Mental Illness. American Psychiatric Association. 2012. Retrieved May 25, 2012 from HYPERLINK “http://www.psychiatry.org/mental-illness”http://www.psychiatry.org/mental-illness

State Laws Mandating or Regulating Mental Health Benefits. National Conference of State Legislatures. 2011. Retrieved May 25, 2012 from HYPERLINK “http://www.ncsl.org/issues-research/health/mental-health-benefits-state-laws-mandating-or-re.aspx”http://www.ncsl.org/issues-research/health/mental-health-benefits-state-laws-mandating-or-re.aspx.