One of the first pieces of legislation to help people gain adequate access to mental health care was passed in 1996. This was when the Mental Health Parity Act was formed. It did not require a lifetime limit or annual dollar limit for mental health care benefits that were lower than medical benefits. However, insurers were allowed to choose maximum numbers for provider visits or limitations for the lengths of hospital stays. Legislation was passed several years ago to outlaw dollar limits. In addition to this, deductibles and copay amounts could not be more restrictive than those included in regular medical benefits.

While employers have considerable amounts of leverage in quickening parity, they often do not see the real impact and cost of the problems for years. Research shows that only about 25 percent of people suffering from mental illnesses will seek help. For those who do seek help, the shortcomings of a mental health benefits plan often surface quickly. Unfortunately, very few people will go to their HR department to voice their concerns. Since there is still a stigma to seeking help for mental health issues, it is more difficult for employers to measure how much their benefits plans are actually being used.

Slightly more than 30 percent of Americans have some form of a mental health disorder. This means that the total number is more than 75 million. Research shows that there are probably employees in almost every workplace suffering from anxiety, depression or some other form of mental illness. Although parity laws have been passed, many insurers will not change their practices until further legislation is passed that would force them to change. Before MHPAEA was passed several years ago, 42 states already had laws in place. However, they were regulated by state insurance commissioners. This means that it is the state commissioner's job to fully enforce plans. The IRS has authority over church-sponsored plans.

Many quantitative treatments are difficult to define. If the same 30-day limit for surgical procedures was defined and imposed for mental health hospital stays, it may be easier to enforce laws. In some states, there are insurance companies that violate MHPAEA rules, but none of the national enforcement agencies have named or fined any of them. Lawmakers and insurers in several states are trying to kill the parity laws. However, this is not true of all insurers. The companies trying to obliterate such laws are the ones that have not yet seen data proving that treatment is cost effective. Research shows that for each dollar spent for mental health treatment, the amount saved for further health costs and lost productivity is $12.

If employers and health plans can prove that the requirements raised their overall costs for two consecutive years, they may be able to opt out of MHPAEA. However, there have not been any requests to opt out yet. Mental health experts see this as progress. Better enforcement tactics could mean a much better benefits marketplace for managers to choose from. Although employers may select plans that sound good on a brochure, they often do not realize how difficult it is for their employees to get the help they need. Good mental health is just as important as good physical health for a stronger workplace, so it is important for employers to be more proactive about following up on employees' success or failure in getting mental health treatment.