More than 1 million Coloradans are living with a diagnosed mental health condition but insurance companies are denying coverage for care their policies promise to pay for.
Jake Williams, CEO of the advocacy group Healthier Colorado, said insurers reject many claims as not medically necessary, even when a doctor has prescribed the treatment.
"Seventy-five percent of Coloradans with commercial insurance, who have a diagnosed mental health condition, have not received the care that they need over this past year," Williams reported. "There are real consequences to this."
In 2008, Congress passed a law requiring insurers to offer the same access to mental health care as to physical care. But a loophole in the law allows insurers to determine what care is "necessary or appropriate."
An investigation by ProPublica found UnitedHealth Group was using algorithms to deny claims, a practice later deemed illegal in three states. United defended its claims program, arguing it ensures patients get safe, effective and affordable treatment.
David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said insurance companies should not be denying care using standards inconsistent with accepted clinical standards. He believes there are roles for both state and federal lawmakers to address the problem.
"We're encouraging policymakers across the board to take some common sense steps to ensure that health plans are ultimately covering the services that they promised to cover when you have health insurance," Lloyd emphasized.
Williams pointed to a bill recently introduced in the Colorado General Assembly as one path forward. The measure would require insurers to cover treatment using criteria developed by the American Academy of Child and Adolescent Psychiatry, or the American Association for Community Psychiatry.
"What we'd like to do is make it uniform," Williams stressed. "So that just like physical health there's a standard definition of medical necessity, so insurers and patients and doctors are all on the same page, and patients are more likely to get these critical services covered."
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As winter drags on with a recent rare burst of snow across North Florida, many Floridians struggle with seasonal affective disorder.
It is a form of depression triggered by shorter days and less sunlight. Mental health professionals across the state are offering practical strategies to help people cope, emphasizing the importance of light exposure, social engagement and seeking professional support.
Judy Charuhas, clinical director of outpatient services for Impower, a Florida-based telehealth provider, said simple acts of kindness can boost a person's mood and emotional well-being.
"Melatonin helps us feel better. Serotonin, endorphins -- when your endorphins get going -- you feel better," Charuhas outlined. "One thing people can do with depression that helps more than anything else is do something for someone else."
A recent study showed 40% of Americans say their mood drops in the winter, 41% are sleeping more, 28% feel fatigued and 27% report experiencing depression.
Lourdes Araujo, president of the Florida Counseling Association, recommended a light therapy box, which mimics sunlight exposure, for those experiencing symptoms.
"If the sunlight goes away, you can extend that time by using this sunlight exposure approach," Araujo explained. "It's really proven to be helpful with depressive symptoms."
She also encouraged cognitive behavioral therapy techniques to challenge negative thoughts and set realistic goals.
Dr. Rhonda Randall, chief medical officer and executive vice president of UnitedHealthcare Employer and Individual, stressed the importance of maintaining social connections and leveraging available mental health resources.
"People who have strong social connections actually live longer," Randall pointed out. "When we think about longevity and quality of life, those strong ties to friends and family are very good to our health."
Randall added many insurance plans offer mental health benefits such as virtual therapy, coaching and digital self-help tools, which can be convenient options for those who struggle during the winter months.
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Some 125,000 children in Michigan struggle with major depression, which can hinder learning, behavior and relationships, according to a recent survey. Research shows the benefits of school-based services to connect them with the care they need.
Together with parents, school mental health resources can help keep kids safe.
Scott Hutchins, who manages the behavioral health unit for the Michigan Department of Education, stresses the importance of these services, especially in light of the pandemic and school shootings.
"Those needs have only been exacerbated since COVID and those other violent tragedies," he said. "So, what mental-health services do is, they allow us to break down the barriers that students need to get the care that they need."
However, the state needs more of these professionals. Michigan has one school psychologist per almost 2,200 students. The recommended ratio is one for every 500 students. The state also requires school districts to include suicide-prevention hotline contact information on IDs for students in grades 7 through 12.
Statistics show youths receiving school-based mental-health services are six times more likely to complete treatment than those receiving community-based services.
Angela Kimball, chief advocacy officer for the nonprofit mental health advocacy group Inseparable, noted that funding is one key challenge in expanding the school mental-health workforce.
"In order to become a licensed professional," she said, "you not only have to pay for schooling, but there's also periods of supervision - where people are essentially working for free and having to pay for supervision as they work towards their credentials."
Kimball said groups like hers are pushing for policies to improve staff ratios and encourage people to consider mental-health careers. In the meantime, if you or someone you know is in crisis, call 988 to be connected with a trained counselor, available 24/7.
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About half of youths experiencing depression in Illinois are not receiving treatment. While the state ranks fairly well nationwide when it comes to youth mental health, officials say there is room for improvement.
Andrea Durbin, CEO, Illinois Collaboration on Youth, said anxiety and depression are at an all-time high, especially with LGBTQ youths and those in immigrant families.
"This is a time for us to be compassionate and empathetic and to embrace folks who are feeling this way and to be supportive, and understand where this is coming from and what our responsibility as adults is to protect them," she said.
The state's Children's Behavioral Healthcare Transformation Initiative passed in 2022. It emphasizes the importance of proactive mental-health screening in schools, similar to vision and hearing tests. Now, a new state law requires yearly mental-health screenings for seventh through 12th grade students.
Despite this progress, barriers to community-based mental-health services for youths still exist and include cost, transportation, insurance issues and stigma.
Angela Kimball, chief advocacy officer with Inseparable, said school-based services that provide different levels of support are one of the most effective tools for supporting student mental health and improving access to care.
"We are starting to see some improvements in student mental health, and that's very encouraging, but the need is still very, very high," she explained. "So we can't let our foot off the pedal now. We really need to do everything we can to build the workforce and to make sure students are supported."
She said youth who get school-based services are six times more likely to complete treatment and have improved long-term education and work outcomes. Yet currently, most state schools don't have the recommended ratio of mental-health staff to students. State-funded programs such as the Behavioral Health Workforce Center are working to address the provider shortage. Kimball added that state policies and initiatives that continue to provide solutions to any roadblocks to mental-health services are crucial to providing youths the care they need.
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