Delaying medical treatment is a higher societal cost

According to a new Gallup poll, nearly three in 10 Americans reported delaying medical care over the past year because of costs. About two in 10 Americans said they delayed care for a serious or somewhat serious medical condition or illness.

Not surprisingly, uninsured patients are the most likely to delay care. Americans with private insurance are more likely to put off care than those with Medicaid or Medicare, perhaps because of high out-of-pocket costs. Even among individuals with higher annual household incomes (defined in the study as less than $75,000 in annual income), an average of about two in 10 Americans have delayed medical care.

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The Gallup poll finds that the percentage of Americans delaying medical care for serious conditions has been relatively stable since 2005.This means that despite rising out-of-pocket health-care costs, there has not been an increase in Americans putting off needed health care.

While this is welcome news, there are still far too many individuals suffering from medical problems that are potentially treatable.

In mental health, delays in seeking treatment are especially problematic. Delays in seeking treatment contribute to suffering at the individual level and contribute to a growing economic burden at the societal level.

According to the National Institutes of Health, about four percent of U.S. adults (or over 10 million people) have a serious mental illness, defined as mental illness symptoms that substantially limit at least one major life activity.

In a given year, only about 65 percent of these individuals receive any kind of treatment, and many receive treatment that is inadequate to produce meaningful change in their lives.

To be sure, stigma, lack of insight into the cause or seriousness of one’s symptoms, individual preferences, deeply held beliefs, and prior negative experiences with mental health professionals or psychiatric medications likely all contribute to a lack of treatment of serious symptoms of mental illness.

But, high costs and lack of access to qualified mental health professionals trained in evidence-based medicine seriously compound the problem.

We work at an academic medical center in a major metropolitan area, Chicago. Here, there are many more psychiatrists, psychologists, and other mental health professionals than found in most suburban and rural areas.

Despite the relatively greater ease of access in Chicago, we still hear, on a nearly weekly basis, from patients, family members, and colleagues struggling to connect themselves or someone they care about to quality psychiatric care. It is a missed opportunity when someone is ready and willing to accept help, only to be told there is a many months waiting list for an initial appointment.

By the time an individual reaches the top of the waiting list, readiness for change may have fizzled, and in many unfortunate circumstances, the individual may have further decompensated.

Finances are frequently a factor in getting care in a timely manner. Individuals who can afford to forego using their health insurance and pay directly for therapy or psychiatric care can find care more quickly, but many people cannot reasonably do this.

This will not be an easy problem to solve, and demands investment in and attention to a number of areas.

Mental health parity, or equal treatment of mental health and substance use problems by private health insurance companies, must be enforced.

The population of psychiatrists is aging, with 60 percent of psychiatrists over the age of 55, contributing to the likelihood that the mismatch between demand for mental health care and availability of psychiatrists will likely increase.

To meet the clear mental health needs of our population in the future, resources need to be devoted not just to training future mental health clinicians (such as psychiatrists, psychologists or social workers), but also to developing technology-enabled mental health services. These can be scaled to help more patients using less clinician time, and to structuring our health-care financial systems to make these types of patient-centered services fiscally possible.

Technology-enabled mental health services, or programs that are delivered remotely and are supported by digital tools and/or apps, hold the potential to reach the tens of thousands of Americans who currently face significant challenges to accessing traditional mental health treatments.

These services have repeatedly demonstrated effectiveness in clinical trials. Access is more available as in many cases, the digital divide has largely vanished, with 95 percent of Americans now owning cell phones and 77 percent owning a smartphone.

Any health care treatment delay is not optimal or in the best long term interest of the individual. But in the presence of mental health concerns, with increasing rates of suicide in our country, it is an unacceptable tragedy for individuals to want help for serious mental illnesses but be unable to access it because of cost or lack of access.

Cara Angelotta M.D. is a forensic psychiatrist and an assistant professor of psychiatry at Northwestern University Feinberg School of Medicine. Emily G. Lattie, PhD is a clinical psychologist is an assistant professor of Medical Social Sciences at Northwestern University Feinberg School of Medicine. Both are public voices fellows with The OpEd Project.