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Serious Mental Illness - SMI

The Issue

For patients with a serious mental illness, tactics, such as prior authorization, step therapy and non-medical switching often place unnecessary strains on patients and providers when seeking treatment. In recent years, SMI has become a significant area of concern for health care advocates and professionals because of its impact on other aspects of a patient’s well-being. AfPA’s Mental Health Working Group focuses on ensuring policies are in place that allow for patient-centered care for those living with a serious mental illness. 

A serious mental illness is defined as any diagnosable mental, behavior or emotional disorder involving serious functional impairment that substantially interferes with or limits one or more major life activities. The most common serious mental illnesses are bipolar disorder, major depressive disorder and schizophrenia.  

Our advocacy for patient-centered care is operationalized through the development and distribution of educational resources for patients and providers that encourage a focus on affordable, accessible care for mental health. Health insurance coverage for mental health services has been limited by various barriers, including step therapy protocols, non-medical switching, co-pay accumulators, and the use of quality-adjusted life year (QALY) metrics in mental health coverage. With continued engagement with policymakers and providers, AfPA hopes to promote positive change for patient access to affordable health care for SMI.  


Supporting Patients with Serious Mental Illness
Meeting Patients Where They Are
ICER Toolkit
How Telehealth Can Help Mental Health Patients
Barriers to Mental Health Care


Federal and State Updates

Below is a list of current legislation that supports patients with serious mental illness. 

Arizona – SB 1083 | HB 2449

Florida – SB 286 | HB 491 

Georgia – HB 1179

Illinois – SB 618  

Maryland – SB 990 | HB 1423

Massachusetts – H 989 | S 631 

New Jersey – S 1192 

North Carolina – HB 680 

Wisconsin – SB 618 | AB 654 

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