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Context Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Evidence acquisition Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Evidence synthesis Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Conclusions Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence is limited for other mental health outcomes.

Men have poorer health and declining social outcomes when compared to women, and research suggests that behaviors related to restrictive and traditional male gender roles contribute to this disparity. This study is an examination of The ManKind Project International (MKPI), a community-based organization that provides alternative male gender norms and a community support system to help reinforce them. The MKPI runs an intensive, experiential "Training Adventure Weekend" (TAW), followed by voluntary, on-going peer-led support and integration groups (I-Groups). One hundred men completed a pre-TAW questionnaire, an interview, and a long-term follow-up (>18 mo.) questionnaire. The study examined if there was change on the primary study variables at follow-up, and the relationship of background characteristics (age, self-help group experience) and factors related to participation (MKPI beliefs, social support, I-Group participation) to the criterion variables (depression symptoms, gender role conflict, and life satisfaction) at follow-up. Results indicated significant change in the expected directions on the primary study variables, suggesting that for these men, participation has a positive impact. Most importantly, changes in MKPI-related beliefs and social support significantly predicted positive outcomes. Also, more positive outcomes were found among men 30-44 years of age, but not among those with more prior self-help experience or I-Group participation. Possible explanations for these findings and directions for further research are discussed.

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