The Affordable Care Act (ACA) will begin this fall in the United States, with the health care exchange signups at the state level. So it’s a good time to pause and reflect. What would an ideal American mental health system eventually look like, and could we get an idea or two from our friends? (We will not be fully serving the mental health needs of the U.S by 2014, when the law becomes operational, but we will be much closer than before.)

There are definite distinctions between the two countries, something those in positions of policy and advocacy in both systems certainly refer to and highlight.

Every person in the U.K. indeed has some form of health coverage. (This in itself, even before dissecting mental health services, is of course distinctive and cannot be stressed enough.) Their definition of health coverage, more to the point, has included mental health.

Debbie Plotnick, who could definitely be described as a policy pro at Mental Health America, gives details that essentially clarify the U.S policies as being in the Dark Ages until 2008, when the Affordable Care Act was signed into law. Only with its passage can the U.S. system even be considered similar to the U.K.

“It’s been very difficult… ” Plotnick begins. “Until 2008, it was legal for U.S. insurance companies to completely deny services for mental health treatment. They would just not cover them.”

The ACA is in the process of changing that with the Mental Health Parity Act, covering mental health and substance abuse. Final regulations will go into effect by the end of the year. Plotnick is confident this component will happen. Many mental health advocates across many states are not so sure, though, and have been nervously lobbying legislators not to push for an about-face.

So if all goes well, the Affordable Care Act will get most individuals in the U.S. health insurance. (The U.K. will still be ahead of the game by covering all.) Mental health in the U.S., too, would finally be a part of health coverage, as in the U.K.

Plotnick expands on this by discussing the private/ public battle so prominent in the U.S. health system. She refers as “patchwork” not only the state/ federal tug of war on policy issues, but also that between private insurers and the public system.

“On the private side — again until very recently — mental health coverage was excluded.” Only through public insurance (Medicaid) was mental health considered part of overall health. Each state has different qualifications for Medicaid, including family income. Thus, as Plotnick said, “Some kids with mental health conditions [of families with] private insurance not covering this could then be automatically picked up by Medicaid.” But not so in various other states.

Also not so in the U.K., where there has been and is a single-payer system and “all is uniform,” according to Plotnick.

Inger Hatloy, information officer of the mental health charity Mind, points out all of the above and goes one step further with this statement about U.S. vs U.K. mental health: “There is, of course, one obvious difference – services provided by the National Health Service (NHS), including mental health services, are free of charge to everyone.”

Would this be the ideal system serving folks Americans in need of mental health treatment? Plotnick offers more, “gladly” giving her opinion on this matter: “An ideal system would also be based on outcomes relevant to quality of life and community inclusion” — whether people “are back in school, found work, and are participating socially in a community.”

As well, Plotnick emphasizes that peer specialists’ support, in the form of coaching and groups, would be better respected. In the U.K., coaching as a model for self- (as well as professional) development is widespread. Plotnick notes that the U.K. has “a lot more community- as opposed to facility-based treatments,” as well as extremely strong “peer movements and peer services” (something that took off in the consumer movement in the U.S. around 1990 but that can still not match that of the U.K.).

Both countries have family groups such as the U.S.’s National Alliance on Mental Illness (NAMI).


If you’re interested in learning more about the similarities and differences between the two countries, the following may be helpful: