Mental Health Is a Luxury

There have been three mass shootings in the US this week, two at military bases. After every mass shooting, we hear a lot of talk from politicians, particularly Republicans, about the need to address mental health. It is all bovine excrement. Mental Health has been the illegitimate step child of public health since the beginning of public health. “Mental Health in this country is a luxury, and luxury is only for the wealthy”, wrote Kastalia Medrano in a recent article on Vox. Truer words have never been spoken.

Mental Health Treatment is not Accessible

Even though half of “mental health” is “health”, it has never been part of our health system let alone our public health system. Mental and emotional disorders are not part of general health care in this nation.

“People who live with mental illness have longer odds on experiencing happiness than their healthy counterparts,” MS Medrano wrote, “but this is because they have more limited access to care.” This is due to several factors.

First, most Americans depend on some sort of health insurance, public or private, for their health care. Until very recently, most policies did not cover mental health. Today, they cover on a very limited basis. Generally insurance policies cover mental health if it is with an in-network provider. It is often difficult get an appointment with an in-network provider on a timely basis.

This brings up the second problem, compared to doctors in all other specialties in the US, psychiatrists are the least likely to accept insurance, and the options for those without private coverage are generally the thinnest of all. So if a person does not have a high enough income, therapy is financially out of reach, and getting more so.

The Federal Government thought it solved the parity problem in the Affordable Care Act by declaring mental health was on par with general health. Studies by the National Alliance on Mental Health (NAMI) show that has not happened. The survey revealed that, despite the requirements of federal parity legislation, people encountered significant barriers to receiving services. People are continuing to confront obstacles to care.

NAMI’s survey found that people with insurance had more difficulty locating in-network providers and facilities for mental health care compared to general or specialty medical care. This was true of both inpatient mental health care (hospitals and residential facilities) and outpatient mental health care (therapists and prescribers of mental health medications). Because out of network providers were often the only reasonable option, many respondents incurred greater costs for mental health compared to other types of specialty care.

One bright spot is that Medicaid recipients were more likely to have an in-network mental health prescriber or therapist than those with private insurance. Medicaid recipients were also more likely to use an in-network psychiatric hospital or residential treatment versus out-of-network facilities. But, many states have not expanded Medicaid, leaving those citizens high and dry.

Another factor complicating the mental health problem is our continual state of war. So many Veterans are returning home with PTSD and it is not being diagnosed or treated as it needs to be. Many shootings, mass or otherwise, could have been prevented by aggressive treatment of PTSD.

Furthermore, substance abuse is a growing problem. It is often difficult for a person to get insurance to cover proper treatment for substance abuse. Many crimes are committed by persons with addictions trying to get the drugs to self-medicate themselves because they see no other options. Law enforcement tends to imprison those without means whereas those with go to re-hab.

There is a Stigma with Mental Health Treatment

Aside from the financial barriers, there is still a stigma associated with mental health treatment. If a person tells someone at work or school they are going to a doctor to have a lump looked at, they usually get a lot well wishes. Seldom, if ever, does one react in a standoffish or negative way. If they say, I am going to a psychiatrist tomorrow; they can usually cut the tension with a knife. The other person is wondering “What is wrong with him or her?” This is usually followed by gossip spreading around the school or workplace—even the extended family.

This stigma prevents many from even seeking help. Or, it prevents those in therapy from getting the peer or family support they need. There is a great likelihood that mental health treatment will make a young person a target of ridicule, butt of jokes, or victim of bullying. Ironically, a high percentage of the mental health issues among school age children are due to bullying. So it is a vicious circle.

The solution is to actually make mental health part of health.