The chapter provides an overview of the current system of mental health services, describing where people get care and how they use services. The chapter then presents information on the costs of care and trends in spending. Only within recent decades, in the face of concerns about discriminatory policies in mental health financing, have the dynamics of insurance financing become a significant issue in the mental health field. In particular, policies that have emphasized cost containment have ushered in managed care. Intensive research currently is addressing both positive and adverse effects of managed care on access and quality, generating information that will guard against untoward consequences of aggressive cost-containment policies.
Parity calls for equality between mental health and other health coverage.
Epidemiologic surveys indicate that one in five Americans has a mental disorder in any one year. Fifteen percent of the adult population use some form of mental health service during the year. Twenty-one percent of children ages 9 to 17 receive mental health services in a year. As a result, care may become organizationally fragmented, creating barriers to access. The system is also financed from many funding streams, adding to the complexity, given sometimes competing incentives between funding sources.