Most health plans cover some treatment for mental health and substance use disorders, but too few people who need these services receive them. Limited requirements for screening and identification of these disorders partially explain this gap in treatment.

Researchers in this study assessed how many health plans required mental health and substance use screening in primary care. They looked at data from a survey of 434 health plans in 1999 and 368 health plans in 2003.

• The proportion of health plans that required screening for mental health or substance use disorders did not substantially change from 1999 (32%) to 2003 (34%).
• Of plans with a screening requirement, there was an increase in the proportion that required alcohol screening (from 33% in 1999 to 78% in 2003) and drug screening (from 8% to 78%).

Comments by Tom Delaney, MSW, MPA:
According to this article, only a minority of healthcare plans mandate screening, although the proportion of these plans requiring alcohol and drug screening is increasing. As screening in primary care becomes more common (partly because of increases in health plan requirements), counselors may find patients more willing to discuss their mental health and substance use. Given the stigma and denial associated with alcohol and drug use diseases, patients may disclose a history of their use more readily if the subject had already been broached by their primary care physician. A counselor, therefore, may be able to facilitate her discussions with patients by first asking if they have been screened by their physicians.

Comments by Peter D. Friedmann, MD, MPH, Associate Editor of Alcohol, Other Drugs, and Health: Current Evidence:
Health plan mandates and reimbursement for substance use screening would encourage primary care physicians to take a greater role in identifying, managing, and referring patients with substance use disorders. The finding that only one-third of health insurance products in 1999 and 2003 required screening for mental health or substance use disorders highlights missed opportunities to improve detection and intervention. Although tracking adherence to such a requirement might be challenging to insurers, the recent addition of procedure codes for substance use screening and brief intervention promises to provide a mechanism for reimbursement and monitoring in the future.