Mental illness includes mental, behavioral or emotional conditions. According to the National Institute of Mental Health 57.8 million adults in the U.S. lived with a mental illness in 2021, yet only 26.5 million received mental health services. Effective treatment for mental health conditions can often lead to reduced workplace accidents and injuries; lower absenteeism and turnover; improved productivity; and decreased disability costs. While effective and available mental health treatment is critical to addressing the mental health crisis, a lack of parity in benefits coverage and other issues prevent millions of people from accessing it.

These issues were a focus of the Mental Health Matters: National Task Force on Workforce Mental Health Policy convened by The Council of State Governments and the National Conference of State Legislatures, in collaboration with the State Exchange on Employment & Disability, funded by the Office of Disability Employment Policy, U.S. Department of Labor. The task force engaged state policymakers and subject matter experts from across the country to explore policy options and actions taken by states to address workforce challenges and employment barriers for people with mental health conditions. Four task force subcommittees explored specific issues. 

The Nondiscrimination, Parity and Benefits Subcommittee identified strategies states can use to better inform workers of their mental health rights. These include strengthening transparency of workplace nondiscrimination and mental health parity policies, expanding employee benefits and educating consumers.

State policymakers have an opportunity to strengthen workplace policies surrounding nondiscrimination and mental health parity. Parity occurs when health insurance plans provide equal coverage for the treatment of physical health conditions and behavioral and mental conditions. However, neither the Mental Health Parity and Addiction Equity Act (MHPAEA) nor Affordable Care Act offer a standard definition for what constitutes a “behavioral health condition” versus a “medical condition” that should be covered under the law. As a result, covered essential health benefits vary across states leading to differences in how insurers interpret mental health claims. States seek to increase insurance company transparency and accountability by strengthening enforcement tools and eliminating ambiguity in state statutes. For example:

• Massachusetts SB 3097 (2022) addressed a broad range of barriers to accessing care for mental health, including the enforcement of mental health parity laws. The legislation creates a clear structure for the Division of Insurance to receive and investigate parity complaints and requires student health insurance plans to comply with the federal MHPAEA.
• Illinois HB 2595 (2021) required insurers to follow relevant nonprofit clinical society guidelines, such as those by the American Society of Addiction Medicine, for medical necessity determinations regarding behavioral health services, minimizing claim denials for mental health and substance use disorder care.
• Virginia HB 1848 (2021) instructed employers with five or more employees to provide reasonable accommodations for otherwise qualified individuals with disabilities, including people with mental health conditions.

States can also support workers with mental health conditions by expanding certain employee benefits through policy directives, such as workers’ compensation, paid sick leave and disability insurance. When filing for workers’ compensation, workers may have difficulty proving a condition is work-related. Establishing presumption policies for professions with a higher likelihood of work-related mental health conditions can increase access to such benefits. For example:

• Minnesota HF 3873 (2018) amended the statute for workers’ compensation to include presumption of eligibility for post-traumatic stress disorder, which is covered under workers’ compensation as an occupational disease, for certain public safety and frontline health employees on active duty.
• Oregon SB 455 (2015) mandated employers with 10 or more employees provide up to 40 hours of paid sick leave annually for all employees. Smaller employers are required to provide 40 hours of unpaid sick leave each year. Under the law, sick time can be used for a mental or physical illness, injury or health condition. It can also be used to care for a family member.

Additionally, consumer education promotes health insurance literacy and clarifies basic concepts of health insurance. In 2020, only 18% — seven million consumers — of those who sought assistance enrolling in the federal health insurance marketplace or Medicaid received it. Furthermore, based on limited available data, insurance companies deny an estimated 10-20% of claims received. As such, states are enacting policies and programs to increase consumer understanding of health care insurance programs. For example:

• Arkansas Health Insurance Marketplace (AHIM) was created as a division of the Arkansas Insurance Department (AID) by Act 107 of 2019. AID provides services and supports to marketplace consumers with health insurance questions or problems through the Consumer Assistance Program.
• Maryland health information exchange allows authorized users to securely and electronically access and share patient health information for clinical, quality improvement, and public health purposes. Maryland H1127 (2022) requires the state-designated exchange to establish a consumer advisory council.
• District of Columbia D.C. Law 15-331 (2004) established the Health Care Ombudsman Program to counsel and assist residents. The Office of Health Care Ombudsman and Bill of Rights assists individuals with issues relating to Medicaid, Medicare, commercial insurance and D.C.’s free health insurance program for eligible residents.
• Connecticut HB 7032 (1999) created the Office of the Health Care Advocate to provide health insurance consumers with information regarding obtainment of health insurance coverage and consumer rights under managed care plans. The office also assists individuals with filing health insurance complaints and appeals, and tracks trends of issues for state, industry, and public stakeholders.

For more information about these findings and others, visit the “Mental Health Matters: Framework on Workforce Mental Health Policy.” This resource outlines policy options to recruit and retain qualified mental health providers; increase access to workplace care and supports; address the unique needs of underserved communities; and enhance mental health parity. Such practices are vital to solve the mental health crisis — and build a stronger, more inclusive workforce and economy.