Is Your Insurance Covering Mental Health? A Deep Dive into Parity Laws

Welcome to Mind Care Guide, your trusted companion on the path to mental well-being. Feeling overwhelmed navigating the complexities of mental health care? You're not alone. Many struggle to understand how insurance truly supports their needs. This article, "Is Your Insurance Covering Mental Health? A Deep Dive into Parity Laws," cuts through the confusion, offering a clear breakdown of mental health insurance coverage details. Are you sure you're getting the coverage you deserve? Discover the answers and empower yourself with knowledge.

Understanding Mental Health Insurance Coverage: Navigating Parity Laws and Accessing Care

What is Mental Health Parity and Why Does it Matter?

Mental health parity refers to the equal treatment of mental health and substance use disorders in insurance plans compared to medical and surgical benefits. This means that things like co-pays, deductibles, treatment limits, and prior authorization requirements for mental health services should be no more restrictive than those for physical health services.

Historically, insurance plans often placed significant limitations on mental health coverage, such as drastically lower annual visit limits for therapy compared to unlimited visits for chronic physical conditions, or much higher co-pays for psychiatric appointments. Parity laws aim to eliminate this discriminatory practice, ensuring that individuals seeking care for mental health conditions face similar financial burdens and access hurdles as those seeking care for physical ailments.

The concept of parity matters profoundly because it directly impacts access to necessary care. Before strong parity protections, the high out-of-pocket costs and restrictive coverage limits often made mental healthcare unaffordable or inaccessible for many, even if they had insurance. Studies and reports from organizations like the National Alliance on Mental Illness (NAMI) have highlighted how financial barriers are a significant reason people don't seek or continue mental health treatment.

By requiring comparable mental health insurance coverage details, parity laws help reduce these financial barriers, making it more feasible for individuals to get the therapy, medication, or other treatments they need to manage their mental health conditions effectively. This not only benefits individuals but also has broader societal impacts, potentially reducing disability, improving productivity, and decreasing overall healthcare costs in the long run.

Decoding Your Mental Health Insurance Plan: A Step-by-Step Guide

Understanding your specific mental health insurance coverage details can feel overwhelming, but breaking it down makes it manageable. The first crucial step is to locate your plan's Summary of Benefits and Coverage (SBC). This document, often available on your insurer's website or provided by your employer, offers a concise overview of what your plan covers.

Look specifically for sections on "Mental Health and Substance Use Disorder Benefits." Pay close attention to the stated co-pays or coinsurance percentages for different types of visits (e.g., office visits for mental health, specialist visits) and how they compare to co-pays for primary care or medical specialist visits. Identify the deductible amount and whether it applies to mental health services, and note the out-of-pocket maximum and if it is integrated for both medical and mental health expenses.

Next, delve into the plan's detailed benefits document, sometimes called the Certificate of Coverage or Plan Document. This provides the full rules and limitations. Here, you'll find specifics on things like whether pre-authorization is required for certain mental health services (such as inpatient treatment, intensive outpatient programs, or even a specific number of therapy sessions), and details about the plan's provider network for mental health professionals.

It's also essential to check for any non-quantitative treatment limitations (NQTLs), which are non-numerical limits like medical necessity criteria, step therapy requirements, or network adequacy standards. Comparing how these NQTLs are applied to mental health versus medical benefits is key to assessing compliance with parity laws and fully understanding your mental health insurance coverage details.

Navigating Federal and State Parity Laws

The Mental Health Parity and Addiction Equity Act (MHPAEA): A Detailed Explanation

The Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law in 2008 and later amended by the Affordable Care Act (ACA), is the cornerstone of federal mental health parity requirements in the United States. This landmark legislation prohibits group health plans and insurers from imposing less favorable benefit limitations on mental health and substance use disorder benefits than on medical and surgical benefits.

This applies to both financial requirements (like deductibles, co-pays, coinsurance, and out-of-pocket maximums) and treatment limitations, which are categorized as quantitative (like visit limits) and non-quantitative (like pre-authorization rules, medical necessity criteria, and network adequacy). For example, under MHPAEA, a plan cannot impose a 20-visit annual limit on outpatient mental health therapy if it does not impose a similar limit on outpatient visits for medical conditions like physical therapy or chiropractic care.

MHPAEA generally applies to most large group health plans (typically employers with 51 or more employees), as well as state and local government plans. The ACA extended parity requirements to most individual and small group market plans (employers with 50 or fewer employees) sold through the marketplaces or directly from insurers. However, certain plans are exempt, such as very small employer plans (fewer than 2 employees) and some "grandfathered" plans that existed before MHPAEA's effective date and haven't significantly changed.

The core principle is that if a plan offers mental health or substance use disorder benefits, those benefits must be provided at parity with medical/surgical benefits. This dramatically changed the landscape, moving away from plans that offered token mental health coverage to requiring equitable mental health insurance coverage details.

State Parity Laws: Understanding Variations in Mental Health Coverage

While MHPAEA provides a federal baseline for mental health parity, many states have enacted their own parity laws. These state laws can vary significantly and may offer stronger protections or apply to a wider range of plans than federal law.

For instance, some state laws may require parity for specific types of mental health professionals or facilities that aren't explicitly detailed under MHPAEA, or they might mandate coverage for conditions that a federal plan might potentially exclude based on broad definitions. State laws can also sometimes apply to plans that are exempt from federal MHPAEA, although fully insured plans (purchased by employers from an insurance company) are typically subject to state laws, while self-funded plans (where the employer pays claims directly) are generally subject only to federal law under the Employee Retirement Income Security Act (ERISA).

Understanding your state's specific parity laws is crucial because they can enhance or clarify the mental health insurance coverage details provided by your plan. Information about state parity laws is often available through your state's Department of Insurance or mental health authority. These state agencies also frequently handle consumer complaints and can assist in navigating complex coverage issues or potential parity violations. By checking both federal and state regulations, individuals can gain a more comprehensive picture of their rights and the expected level of coverage for mental health services.

Common Coverage Restrictions and How to Identify Them in Your Insurance Policy

Even with parity laws in place, insurance policies can contain restrictions that may be applied in ways that violate parity or simply make accessing care more difficult. Common quantitative restrictions, though less frequent now due to parity, might include explicit annual limits on the number of outpatient therapy sessions (e.g., 30 visits per year), which should be compared to any limits on physical therapy or other specialist visits.

More complex are non-quantitative treatment limitations (NQTLs). These can include requirements for prior authorization for mental health services that aren't required for comparable medical services, overly stringent medical necessity criteria for approving mental health treatment duration or intensity, or inadequate networks of mental health providers compared to medical specialists.

Identifying potential parity violations or restrictive NQTLs requires careful review of your plan documents. Compare side-by-side how financial requirements (co-pays, deductibles) and treatment limitations (prior authorization rules, utilization review processes, network composition) are applied to mental health benefits versus medical/surgical benefits. Look for inconsistencies or requirements that seem disproportionately burdensome for mental healthcare.

For example, if your plan requires you to get pre-authorization for every therapy session after the first one, but only requires pre-authorization for expensive, specialized medical procedures, this might indicate a potential parity issue. Documenting these discrepancies is the first step if you suspect your mental health insurance coverage details are not compliant with parity laws.

Assessing Your Mental Health Insurance Coverage Details

Key Questions to Ask Your Insurance Provider About Mental Health Benefits

Navigating your mental health insurance coverage details requires asking specific, targeted questions. When contacting your insurance provider, be prepared to ask about:

• What are my co-pays for in-network outpatient mental health visits (therapy, psychiatry)? How do these compare to co-pays for primary care doctor visits or medical specialist visits?
• Do I have a separate deductible for mental health services, or is it integrated with my medical deductible? What is the amount, and how much have I met?
• What is my out-of-pocket maximum for mental health services? Is it the same as my medical out-of-pocket maximum?
• Are there any visit limits for outpatient therapy or counseling sessions? If so, how many, and how do these limits compare to limits on other specialist visits like physical therapy?
• Is pre-authorization required for any mental health services, such as inpatient treatment, partial hospitalization programs, or specific types of therapy? What is the process and criteria for obtaining authorization?

Additionally, inquire about the plan's network of mental health providers:

• How can I find an in-network therapist, psychologist, or psychiatrist? Is the online provider directory up-to-date?
• Are there different co-pays or benefits for seeing a licensed social worker (LCSW), licensed professional counselor (LPC), psychologist (PsyD/PhD), or psychiatrist (MD)?
• What are the benefits if I see an out-of-network mental health provider? Does anything count towards my deductible or out-of-pocket maximum? Is there a significant difference in cost compared to in-network?
• Does my plan cover teletherapy or online mental health services? If so, are there specific approved platforms or providers? Getting clear answers to these questions will provide essential mental health insurance coverage details.

Understanding Co-pays, Deductibles, and Out-of-Pocket Maximums for Mental Health Services

Co-pays, deductibles, and out-of-pocket maximums are fundamental components of any insurance plan, including for mental health benefits. A co-pay is a fixed amount you pay for a covered service after you've met your deductible, if applicable (e.g., $40 per therapy session). A deductible is the amount you must pay out-of-pocket each year before your insurance plan starts to pay for covered services.

For instance, if you have a $1,500 deductible, you pay the first $1,500 of covered healthcare costs, including mental health visits, before your insurance contributes. Parity laws generally require that co-pays and deductibles for mental health services are comparable to those for medical/surgical services in the same classification (e.g., outpatient specialist visit).

The out-of-pocket maximum is the most you will have to pay for covered services in a plan year. Once you reach this limit, your insurance plan pays 100% of the cost for covered services for the rest of the year. Parity requires that the out-of-pocket maximum for mental health and substance use disorder benefits must be no higher than the out-of-pocket maximum for medical/surgical benefits.

Ideally, plans should have a single, integrated out-of-pocket maximum that applies to all covered benefits, both medical and mental health. Understanding how these financial elements apply to your mental health insurance coverage details is crucial for budgeting and predicting costs.

In-Network vs. Out-of-Network Mental Health Providers: What's the Difference?

Choosing between an in-network or out-of-network mental health provider has significant financial implications. In-network providers are healthcare professionals who have contracted with your insurance company to provide services at negotiated rates. When you see an in-network provider, you typically pay a lower co-pay or coinsurance, and the amount you pay counts towards your deductible and out-of-pocket maximum.

Insurance companies encourage the use of in-network providers by making it more cost-effective for the patient. Parity laws stipulate that the network of mental health providers should be adequate and comparable to the network of medical/surgical providers in terms of accessibility and availability.

Out-of-network providers do not have a contract with your insurance company. If you see an out-of-network provider, your plan may cover a smaller portion of the cost, or none at all. You will likely pay a higher coinsurance percentage or the full cost upfront and then submit a claim for partial reimbursement. The amount paid might not count towards your deductible or out-of-pocket maximum.

Furthermore, out-of-network providers can "balance bill" you, meaning they can charge you the difference between their full fee and what your insurance plan pays. While some plans offer some coverage for out-of-network mental health care, it is almost always significantly more expensive than staying within the network. Being aware of the network status of potential providers is a critical part of understanding your mental health insurance coverage details.

Common Mental Health Treatments and Insurance Coverage

Coverage for Therapy and Counseling: Individual, Group, and Family

Insurance plans typically cover various forms of psychotherapy, commonly known as therapy or counseling. This includes individual therapy (one-on-one sessions with a therapist), group therapy (sessions with a therapist and other patients facing similar issues), and family therapy (sessions involving family members). Coverage often depends on the provider's licensure (e.g., psychologist, licensed clinical social worker, licensed professional counselor, marriage and family therapist). Parity laws require that if a plan covers outpatient visits for medical specialists, it must cover outpatient visits for mental health professionals comparably, meaning similar co-pays, deductibles, and lack of restrictive visit limits compared to medical visits.

While parity has largely eliminated arbitrary annual visit caps common in the past (like limiting therapy to 20 sessions per year when physical therapy had no such limit), some plans may still require pre-authorization for therapy after a certain number of sessions or for specific types of therapy. The medical necessity criteria used to evaluate the need for continued therapy should also be comparable to the criteria used for other medical treatments.

It's important to clarify with your insurer whether your plan covers specific modalities you might be interested in and if any authorization steps are needed to ensure seamless mental health insurance coverage details for your therapy.

Medication Management: Insurance Coverage for Psychiatric Medications

Insurance coverage for psychiatric medications falls under the plan's prescription drug benefit, which operates based on a formulary. A formulary is a list of prescription drugs covered by the plan, usually organized into tiers (e.g., Tier 1 - preferred generics, Tier 2 - non-preferred generics, Tier 3 - preferred brand, Tier 4 - non-preferred brand, Tier 5 - specialty). Medications on lower tiers generally have lower co-pays or coinsurance. Psychiatric medications, like antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotics, are included in these formularies and are subject to the same tiering and cost-sharing structure as medications for physical conditions.

However, parity issues can arise with medication management through the application of non-quantitative limitations like prior authorization and step therapy. Prior authorization might be required for certain psychiatric medications, meaning your doctor needs to get approval from the insurer before you can fill the prescription. Step therapy (sometimes called "fail first") requires you to try one or more less expensive, preferred drugs before the plan will cover a more expensive alternative.

Parity requires that these rules and processes for psychiatric medications are applied no more restrictively than they are for medications used to treat physical health conditions. For example, if a common high blood pressure medication doesn't require prior authorization, a common antidepressant shouldn't either, based on parity principles governing mental health insurance coverage details.

Inpatient and Outpatient Mental Health Treatment: What to Expect from Your Insurance

More intensive levels of mental healthcare, such as inpatient hospitalization for acute psychiatric crises or residential treatment for substance use disorders, are also subject to insurance coverage rules and parity requirements. Inpatient treatment involves staying in a hospital or specialized facility, while intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) provide structured therapy and support for several hours a day, multiple days a week, without requiring overnight stays. Coverage for these services is almost always subject to medical necessity review and pre-authorization by the insurance company.

Parity requires that the criteria used by the insurer to determine the medical necessity for these higher levels of mental health care are comparable to the criteria used for medical/surgical inpatient stays or intensive rehabilitation programs (like physical rehabilitation after surgery). The financial requirements, such as daily co-pays or coinsurance, and any duration limits applied to mental health inpatient or intensive outpatient programs must also be no more restrictive than those applied to comparable medical/surgical services.

It's crucial to confirm that the facility or program is in-network and understand the specific authorization process and financial responsibilities associated with these higher levels of mental health insurance coverage details.

Challenging Denials and Appealing Insurance Decisions

Understanding Your Rights When Your Mental Health Claim is Denied

Receiving a denial for a mental health claim can be frustrating and distressing, but it's important to know that you have rights and options. Insurance denials are not always final. Under federal law, including the Affordable Care Act and MHPAEA, if your insurance company denies coverage for a mental health service or treatment, they must send you a written denial letter. This letter must clearly state the specific reason for the denial (e.g., not medically necessary, not covered benefit, provider out-of-network, pre-authorization not obtained) and explain the process for appealing the decision.

You have the right to access the information the insurer used to make their decision, including the specific criteria for medical necessity or the plan's policy language. You also have the right to an internal appeal with the insurance company itself and, if that is denied, the right to an external review by an independent third party. Knowing these fundamental rights is the essential first step in challenging a decision that impacts your mental health insurance coverage details and access to care. Do not hesitate to request clarification on the denial reason if it is unclear.

Steps to File an Internal Appeal with Your Insurance Company

If your mental health claim is denied, the first formal step to challenge the decision is typically an internal appeal with your insurance company. The denial letter should provide instructions on how to file an appeal and the deadline for doing so (often 180 days from the date of the denial notice). To file an effective internal appeal, you should:

• Review the denial letter carefully to understand the exact reason for the denial.
• Gather supporting documentation. This is critical. It should include a letter from your mental health provider explaining why the service or treatment is medically necessary for your specific condition, your treatment plan, and any relevant medical records. Also include copies of the denial letter and any communication with the insurer.
• Write a clear and concise appeal letter. Explain why you believe the denial was incorrect, referencing the information from your provider and potentially citing relevant terms from your plan document or even parity principles if you suspect a violation. Include your policy number, claim number, and contact information.
• Submit your appeal and all supporting documents according to the insurer's instructions, making sure to meet the deadline. Send it via certified mail or a method that provides proof of delivery, and keep copies of everything for your records.

The insurance company is required to respond to your internal appeal within a specific timeframe, typically 30 days for pre-service (before you receive the care) and 60 days for post-service (after you've received the care) claims. A thorough and well-documented internal appeal significantly increases your chances of having the denial overturned and securing your mental health insurance coverage details.

Seeking External Review: When and How to Escalate Your Case

If your internal appeal is denied by the insurance company, you generally have the right to request an external review. This is a valuable opportunity to have your case reviewed by an independent third party who has no financial ties to your insurance company. External review is particularly important if you believe the insurer's denial involved a misapplication of their policy, a disagreement about medical necessity, or a potential violation of parity laws regarding your mental health insurance coverage details.

The denial letter for your internal appeal should provide information on how to request an external review and the deadline for doing so (often 60 days from the date of the internal appeal denial). You typically submit your request to your state's insurance department or an assigned independent review organization (IRO). The IRO will collect relevant documents from you and the insurance company and have medical experts review the case.

Their decision is legally binding on the insurance company. This external review process provides an impartial assessment of whether the insurer's denial was appropriate based on the terms of your plan and applicable laws, offering a crucial avenue for recourse if your initial appeal is unsuccessful.

Finding Affordable Mental Healthcare Options

Utilizing Employee Assistance Programs (EAPs) for Mental Health Support

Beyond traditional insurance, several avenues exist for accessing affordable mental healthcare. One valuable resource often available through employers is an Employee Assistance Program (EAP). EAPs are confidential, short-term counseling services provided at no cost to employees and sometimes their family members. They are designed to help individuals address personal or work-related problems, including stress, anxiety, depression, relationship issues, and substance use concerns.

EAPs typically offer a limited number of free counseling sessions (e.g., 3 to 6 sessions per issue). While not intended for long-term or severe mental health conditions, they can be an excellent starting point for addressing immediate needs, gaining coping strategies, or getting referrals to longer-term care providers. Utilizing your EAP does not involve your main health insurance and does not require using your mental health insurance coverage details or submitting claims, making it a private and accessible option for initial support.

Community Mental Health Centers: Affordable Access to Care

Community Mental Health Centers (CMHCs) are another vital resource for affordable mental healthcare, particularly for individuals with limited income, those who are uninsured, or those with public insurance like Medicaid or Medicare. CMHCs are often publicly funded and provide a wide range of services, including individual and group therapy, psychiatric evaluation and medication management, crisis intervention, and case management.

These centers typically offer services on a sliding fee scale based on income, making care significantly more affordable than private practices. While wait times can sometimes be a factor due to high demand, CMHCs play a crucial role in providing accessible mental health services within communities. They can be a primary source of care or a bridge to other resources, complementing or sometimes replacing the need to rely solely on private mental health insurance coverage details.

Teletherapy and Online Mental Health Services: Expanding Access and Affordability

The rise of teletherapy and online mental health platforms has significantly expanded access to care and, in some cases, improved affordability. Teletherapy involves receiving therapy or psychiatric services remotely via video conferencing or phone. Many insurance plans, especially since 2020, have increased coverage for teletherapy, often covering it at the same rate as in-person visits, though it's essential to verify your specific mental health insurance coverage details.

Beyond traditional teletherapy covered by insurance, various online platforms offer subscription-based models or direct-pay options for therapy and medication management that may be more budget-friendly than traditional out-of-network fees. These platforms can be particularly beneficial for individuals in rural areas, those with mobility issues, or those who prefer the convenience of receiving care from home. While confirming insurance coverage is always recommended, these digital options provide alternative pathways to mental wellness that might be more accessible or affordable for some individuals.

The Future of Mental Health Insurance Coverage

Emerging Trends in Mental Health Benefits and Coverage

The landscape of mental health insurance coverage is continuously evolving, driven by increased awareness, advocacy, and regulatory changes. Emerging trends include a greater focus on preventative mental health services, with some plans beginning to cover digital tools like mental wellness apps or online cognitive behavioral therapy programs. There's also a growing emphasis on integrated physical and mental healthcare models, where primary care physicians and mental health professionals work together more closely, which can lead to better coordinated and potentially more cost-effective care.

Employers are increasingly recognizing the importance of employee mental health and are offering more robust benefits, sometimes including enhanced EAPs, on-site counselors, or partnerships with mental health platforms. Value-based care models, which tie payment to patient outcomes rather than just the volume of services, are also being explored in mental health to incentivize effective and efficient treatment. These trends suggest a future where mental health insurance coverage details may become even more comprehensive and integrated into overall health and wellness strategies.

Advocacy Efforts to Improve Mental Health Parity

Despite the progress made with laws like MHPAEA, advocacy efforts continue to strengthen mental health parity and ensure its effective enforcement. Organizations like The Kennedy-Satcher Center for Mental Health Equity and the National Alliance on Mental Illness (NAMI) actively work to identify loopholes in current regulations and push for policies that close gaps in coverage and access. A major focus is on ensuring that non-quantitative treatment limitations (NQTLs), such as network adequacy standards, prior authorization processes, and medical necessity criteria, are truly applied at parity and do not create hidden barriers to care.

Advocates also play a crucial role in educating consumers about their rights under parity laws and helping them navigate the appeals process when claims are denied unfairly. Lawsuits against insurance companies for alleged parity violations have also been instrumental in highlighting enforcement gaps and pushing insurers to comply more fully with the law. These ongoing efforts are vital to translate the promise of mental health parity into tangible improvements in mental health insurance coverage details and access to care for individuals and families.

The Impact of the 2024 Final Rules on Access to Mental Healthcare

A significant recent development impacting mental health insurance coverage is the release of final rules in 2024 by the Biden administration aimed at strengthening the enforcement of MHPAEA. These rules require insurers to perform a more stringent analysis demonstrating that their non-quantitative treatment limitations (NQTLs) are applied no more restrictively to mental health and substance use disorder benefits than to medical/surgical benefits. Importantly, insurers must make this analysis available to federal or state regulators and potentially to consumers upon request.

The expectation is that these new rules will lead to increased scrutiny of insurer practices regarding things like network adequacy (ensuring enough mental health providers are available and accessible), prior authorization requirements, and utilization review processes. By requiring insurers to prove parity in how they apply these limitations, the rules aim to reduce unfair denials and improve access to necessary mental healthcare services.

While the full impact will unfold over time as the rules are implemented and enforced, they represent a substantial step towards realizing true parity and ensuring that mental health insurance coverage details genuinely support access to care.

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Navigating insurance for mental health can be complex, but understanding parity laws and your rights is a powerful tool. If you encounter difficulties accessing care or believe your plan is not complying with parity, consider reaching out to your state's Department of Insurance or a mental health advocacy organization for assistance.

Final Reflection: The Urgent Need for Accessible Mental Healthcare

The fight for equitable mental healthcare access is far from over, and understanding the intricacies of parity laws is crucial in this ongoing battle. Millions still struggle to access the care they desperately need, highlighting the critical gap between legislation and real-world application. The complexities of insurance policies, coupled with the stigma surrounding mental illness, create significant barriers that prevent individuals from receiving timely and effective treatment.

The impact of inadequate mental healthcare access ripples through our communities, affecting not only individuals but also families, workplaces, and society as a whole. The emotional and economic costs are immeasurable. Mental health is not a luxury, but a necessity. It's time we treat it as such. This simple statement underscores the profound truth that accessible, affordable mental healthcare is not a privilege, but a fundamental human right. The ongoing struggle to achieve true parity reflects a larger societal issue – the need to prioritize mental well-being with the same urgency and resources dedicated to physical health.

Now, consider your own life. Have you or someone you know faced challenges navigating the mental healthcare system? Take a moment to reflect on the information presented in this article and consider how you can advocate for change.

Whether it's understanding your own insurance coverage, supporting organizations dedicated to mental health advocacy, or simply engaging in open conversations about mental well-being, every action, no matter how small, contributes to a larger movement towards a more equitable and compassionate future. Let's work together to dismantle the barriers to care and ensure that everyone has access to the mental healthcare they deserve.

Unlock Your Mental Healthcare Rights Now!

Thanks for taking the time to learn about mental health parity laws—you've taken a crucial step towards better understanding your healthcare coverage. Now, let's turn that knowledge into action!

• Contact your insurance provider directly: Verify your coverage for mental health services, including the specific limitations and reimbursements. This is the most important step to ensure you're getting the care you deserve.
• Share this article with your network: Spread awareness about mental health parity and empower others to advocate for their own well-being. Let's make sure everyone has access to the support they need.
• Explore additional resources: Dive deeper into mental health advocacy groups and find support networks in your community. This could be a powerful step toward building a more supportive environment for mental health.

So, what resources will you explore first to further protect your mental health rights?