In 2010 the Mental Health Parity and Addiction Equity Act (MHPAEA) mandated that most health insurance plans offer similar access and cost structures for general medical and behavioral health services. Passage of national parity was delayed by fears that greater access to behavioral health care would increase use and drive up costs, and MHPAEA provisions were added to allay these concerns. Will greater use of mental health and substance abuse treatments in the coming years escalate spending by insurance plans and thus drive up costs borne by employers and enrollees? Answering this question will require baseline data on insurance plan expenditures. Tami L. Mark, Ph.D., M.B.A., and colleagues analyzed data from claims paid by large group plans between 2001 and 2009. The plans covered from five million to 17 million persons, depending on year. Expenditures for behavioral health treatment contributed .3% per year, on average, to growth in overall health spending. The contribution fell to .1% when analyses excluded prescription for psychotropic drugs, which most plans covered on parity with other medications. More than 90% of enrollees used well below the maximum 30 inpatient days or outpatient visits typically covered by health insurance plans before parity. Simulations indicated that even large increases in use would raise total health care expenditures by less than 1% (page 313).

“Suppose a pill existed that would allow you to permanently and completely avoid ever having [health condition]. … Please estimate the maximum dollar amount you would be willing and able to pay monthly for this treatment?” This question was asked of a nationally representative sample of 710 adults in regard to three general medical conditions—diabetes, below-the-knee amputation, and partial blindness—and two mental illnesses—depression and schizophrenia. Respondents were also asked to rate the “burdensomeness” of each condition. When Dylan M. Smith, Ph.D., and colleagues analyzed the responses, they were surprised to find that even though respondents rated the two mental illnesses as relatively more burdensome than the other conditions, the amount they were willing to pay to avoid them was 40% lower. The authors note that “public attitudes likely influence how much payers for health care are willing to spend to treat mental illness and how likely federal agencies are to invest in research” (page 319).

Medical services for U.S. smokers are estimated to cost $75.5 billion a year. Smoking cessation interventions are among the most cost-effective prevention services. To determine the extent to which veterans with mental disorders who smoke receive cessation services, Sonia Duffy, Ph.D., R.N., and colleagues analyzed data from a large (N=224,193) Veterans Health Administration survey of outpatient care. From 60% to 80% of those with various mental disorders reported receiving at least one cessation service, but smoking rates remained high, and some subgroups were significantly less likely to receive these services (page 325). In a Taking Issue commentary, Seth Himelhoch, M.D., M.P.H., notes that “mental health care providers must come to terms with the fact that smoking has reached epidemic proportions among their patients” and overcome their historical reluctance to provide interventions (page 303).

Four studies examine child and adolescent services and treatment needs. In California, Todd P. Gilmer, Ph.D., and colleagues conducted focus groups of transition-age youths (age 18 to 24) and their parents and providers to determine needs for services and supports (page 338). Trina E. Orimoto, M.A., and coauthors report on the therapy practices of nearly 300 leading child and adolescent therapists in Hawaii (page 343). Emily Harris, M.D., M.P.H., and colleagues examined how often Medicaid-enrolled children prescribed antipsychotics also received psychosocial interventions or other concurrent therapy (page 351). A controlled study conducted by Mary Jo Coiro, Ph.D., and colleagues examined whether treating mothers' depression could reduce the substantial negative effects of maternal depression on children's behavior and adaptive skills (page 357).

• The Law & Psychiatry column examines U.S. courts' continued refusal to consider the mental state of defendants in determining civil liability (page 308).

• Advocates in New York describe cases in which legal immigrants with court orders to enter inpatient care have instead been detained and deported by U.S. Immigration and Customs Enforcement (page 377).