The huge cultural overlap between the U.S. and U.K. covers many elements of life in the countries, but healthcare is one area with a historical divide. The U.K., like Canada, has what is disparagingly referred to as “socialized healthcare,” whereas the U.S. system is privatized, turning the requirement for good health into an opportunity for profit. Hefty health insurance premiums drive 47.5 million Americans to go without coverage, meaning that any medical expenses fall firmly on their shoulders.
When it comes to mental health and substance use disorders, the situation is considerably worse, with many insurance providers offering limited coverage, which is frankly inadequate for severe cases. However, with new legislation promising to improve the situation drastically, many people have begun to wonder what the ideal system for healthcare would look like. In comparing the U.S. with the U.K., a picture begins to develop of the future of U.S. substance abuse and mental health treatment, and inklings of the idealistic dream sharpen into view.
In the United Kingdom, the system is comparatively simple. Healthcare is primarily handled by the National Health Service (NHS), for which each working citizen has to pay about 11 percent of their income to National Insurance. This fee is paid regardless of whether you use services, as long as you earn over $170 (£110) per week (although the money also goes to additional services, including unemployment benefits and state pensions). The upside of this approach is that—in simple terms—if you’re ill, you receive treatment free of charge, and if you’re unemployed or poor, you don’t have to pay anything at all. The critical feature of the system for those in need of mental health is that the definition of health coverage in the U.K. includes mental health.
In practice, this means that mental health services are an integrated part of the system. The national service framework for mental health (implemented after widespread reforms in 1999) focuses on providing care close to home, offering 24/7 service, access to modern medicines, the use of tailored treatment programs, early intervention for those at risk, using talking therapies such as cognitive behavioral therapy, and providing multi-disciplinary care. In 2009, a similar strategy – New Horizons – was launched; it focuses on similar points but places a particular emphasis on attempting to reduce the stigma attached to mental illness.
In the United States, prior to the Affordable Care Act, mental health services were often excluded from private health insurance plans. This meant that only those on Medicaid were eligible for mental health services, which covered everybody under the Federal Poverty Level (currently $23,550 for a family of four), but allowed states to set their own minimums (provided it wasn’t below that amount). This led to much disparity among the states, with additional eligibility criteria for Medicaid severely limiting the options available to many Americans.
For those not eligible for Medicaid, private insurance didn’t offer support for mental health until 2008. When it was covered, there were often limitations on the length of time services could be used and other requirements that were not placed on other conditions. The Mental Health Parity and Addiction Equity Act aimed to change this, expanding the equity in services offered by state Medicaid to 82 million Americans in health plans provided by their employers. Mental health is now essentially covered in the same way as medical or surgical care. Additional changes set to come in at the start of 2014 will set a national minimum level for Medicaid support at 133 percent of the Federal Poverty Level, widening the scope of coverage.
The Future of Mental Health Care?
The expansion of mental health coverage in the U.S. to more closely match what is provided in the U.K. is an emphatic step forward for public health. The U.K. system isn’t perfect, of course, but there are still many elements envied by experts like Debbie Plotnick of Mental Health America, who spoke to PsychCentral about her “ideal” system. She pointed out the focus on community-based treatment services in the U.K. as a benefit, as well as the wide availability of peer services and movements. However, like many people, she primarily would like to see a focus on real-world outcomes in psychological treatment, like continuing education and finding work.
Although it has staunch critics, “Obamacare” is a good thing for those in need of mental health services. By more closely mirroring the comparatively idealistic system in the U.K., it means that more people in the U.S. will be able to receive the treatment they need because mental health services will be available, regardless of income level. While there may always be a divide between the healthcare policies of the two nations, we all realize that people in need should be receiving support. An “ideal” system may be a fanciful, unrealistic dream, but moving toward it should be a continuous goal.