Breaking down the barriers to mental health care
Life in the U.S. changed dramatically over the past 15 years. The 2001 terrorist attacks on this country changed our laws, rights, economy, business practices, worldviews, spending and health. As U.S. troops began to invade Afghanistan, the opioid crisis began here in the homeland. Multiple invasions of multiple countries coincided with unemployment and economic crisis, which continues today. It is not surprising that mental illness and substance use disorders are at an all-time high.
Half of Americans need help
There are about 39 million more people living in the U.S. now than in 2001, so obviously more people will require treatment, increasing overall costs. Still, the incidence of mental illness has increased significantly, with a current lifetime prevalence of 50 percent. Suicide, overdose, and substance-related accidents and diseases are now leading causes of death. The Affordable Care Act and Mental Health Parity Act were supposed to help people receive the treatment they need, yet only a small percentage receive it.
Financial concerns are a major barrier. In 2001, total spending for mental health and substance use disorder treatment in the U.S. totaled $104 billion. By 2009, it was up to $171 billion and expected to reach $280.5 billion in 2020. However, it is unclear how much of that spending comes from insurance companies and how much comes from out-of-pocket costs.
High deductibles, uncovered services and the high cost of prescription medication can mean the difference between getting help or not. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was supposed to ensure that behavioral health care services were reimbursed by insurance companies on par with physical medical care, but parity has been difficult to enforce. A national survey report showed that unaffordability was the number one reason for not receiving mental health services among adults who needed it.
In all fairness to the insurance companies, that national survey report was conducted after only about a year after the MHPAEA was finally enacted in 2010. Many people were not even aware that they were eligible for treatment coverage. Many were still not aware that they were eligible in a 2014 study by the American Psychological Association.
Furthermore, the American Psychiatric Association also revealed that about half of psychiatrists in the U.S. don’t accept insurance. There are other barriers to care as well, such as stigma and fear of institutionalization. Recent aggressive gun laws threaten individuals with mental illness with the loss of their right to bear arms, despite the fact that the mentally ill are no more violent than the general population. But if people knew that their mental health care is covered and their provider accepts insurance, it would likely go a long way toward helping the tens of millions of people who need care but are not receiving it.
There seems to be some misperceptions about what mental health care services involve. First of all, most Americans do have coverage for care, although getting the actual reimbursement might involve a bit of a struggle. Next, privacy and confidentiality are protected by law, so no one will know whether a person receives treatment unless that person discloses the information. Also, the whole issue of stigma is rather ridiculous, especially when half the population experiences mental illness.
Many people underestimate their own stress level and overestimate their ability to cope. They may go on for years suffering in silence when treatment can help them feel better in a relatively short period of time. There are many different therapeutic settings, levels of care, duration of treatment and types of modalities used. New modalities such as pharmacogenetics, neurofeedback, nutritionally assisted detox, dialectical behavior therapy are available, and people
Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health, a behavioral health treatment provider with locations throughout the United States. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. Follow her on Twitter.
The views expressed by contributors are their own and are not the views of The Hill.