title: Effects of mental health benefits legislation: a community guide systematic review.
abstract: BACKGROUND
  Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health.
  
  
  METHODS
  Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012.
  
  
  RESULTS
  Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes.
  
  
  CONCLUSIONS
  Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence was limited for other mental health outcomes.
authors.affiliation: Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC. Electronic address: tsipe@cdc.gov.
authors.forename: Theresa Ann
authors.initials: TA
authors.lastname: Sipe
authors.affiliation: Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
authors.forename: Ramona K C
authors.initials: RK
authors.lastname: Finnie
authors.affiliation: Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
authors.forename: John A
authors.initials: JA
authors.lastname: Knopf
authors.affiliation: Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
authors.forename: Shuli
authors.initials: S
authors.lastname: Qu
authors.affiliation: Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Reynolds
authors.affiliation: Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
authors.forename: Anilkrishna B
authors.initials: AB
authors.lastname: Thota
authors.affiliation: Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hahn
authors.affiliation: Emory University, Truven Health Analytics, and Thomson Reuters, Atlanta, Georgia.
authors.forename: Ron Z
authors.initials: RZ
authors.lastname: Goetzel
authors.affiliation: Substance Abuse and Mental Health Services Administration, Rockville.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hennessy
authors.affiliation: Division of Population Health, CDC.
authors.forename: Lela R
authors.initials: LR
authors.lastname: McKnight-Eily
authors.affiliation: Division of Population Health, CDC.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Chapman
authors.affiliation: American Psychological Association, Washington, District of Columbia.
authors.forename: Clinton W
authors.initials: CW
authors.lastname: Anderson
authors.affiliation: National Institute of Mental Health, Bethesda, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Azrin
authors.affiliation: Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Ana F
authors.initials: AF
authors.lastname: Abraido-Lanza
authors.affiliation: Department of Psychiatry, Penn State Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Gelenberg
authors.affiliation: Division of Adolescent and School Health, CDC.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Vernon-Smiley
authors.affiliation: American Academy of Family Physicians, Denver, Colorado.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Nease
mesh_terms: D003153:Community Health Services; D005260:Female; D005102:Health Expenditures / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D001523:Mental Disorders / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D011787:Quality of Health Care