Chances are good someone close to you is suffering from a mental health disorder right now. You may not know it.
Chances are also good that you don't have the knowledge or resources to deal with an extended bout of mental illness suffered by a family member. This was a primary concern in the recent passage by the House of the Helping Families in Mental Health Crisis Act, which seeks to overhaul the American mental health care system and awaits companion Senate legislation.
New laws that fund more treatment will be helpful, to be sure, but the Helping Families Act will probably be more initial salvo than decisive blow, given what the nation is up against when it comes to mental illness. The Centers for Disease Control estimates that 25 percent of Americans have a mental illness, and almost 50 percent will face at least one mental health challenge at some point in their lives. The Department of Health and Human Services says 8 percent of Americans could benefit from drug or alcohol treatment.
These are eye-opening figures that most outside the mental health community probably don’t know about. Here are some more.
* A recent study says the nation's psychiatric bed total has fallen 17 percent since 2010 and now stands at 11.7 beds per 100,000 people, an average far below the rest of the developed world.
* According to Health Affairs, two-thirds of primary care physicians are unable to find a mental health professional to care for their patients after diagnosis.
* A 2012 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) showed that almost 40 percent of adults with severe mental illnesses (schizophrenia, bipolar disorder) received no treatment in the previous year; among those with any kind of mental illness, 60 percent went untreated.
* According to Insel and NIMH research, mental illness costs America about $444 billion a year, with a third of that going to medical care and the majority to disability payments and lost productivity.
I could add more bullet points to this list above, but you get the idea. And, no, I am not suggesting the solution to each of these problems is the same. I am suggesting that the solution is to treat mental health as one component in overall health and start to develop a legitimate mental health system. It can happen on the state level, but those states need to share data or we end up with silos and ineffectiveness. And the federal government must get involved or there simply is not enough money to make this happen. The feds are certainly aware of America’s converging mental health challenges, but in many ways they seem more interested in measuring than addressing them.
So, what can we do right now to start to grapple with America’s looming mental health crisis?
* Restore the psychiatric beds lost during the economic downturn. Most states cut budgets during the recent recession, which hit mental health facilities particularly hard. Tax revenues are starting to tick up, but the federal government will probably have to get involved through block grants or other incentives to bring beds back online.
* Push the Accountable Care Organization model. Currently, ACOs are happening through the Affordable Care Act. Because ACOs are responsible for the entire patient, not just that deep cut or broken finger, there is a pathway for treatment of mental health and addiction challenges.
* Expand health IT incentives to mental healthcare. Reporting requirements for mental health facilities are getting more stringent, and yet most are still managing with paper records. Without Medicare and Medicaid reimbursement, many mental health and addiction facilities will go under, leaving even fewer beds available. If we believe that computers are a benefit with physical and surgical care, then they are also a benefit with mental healthcare.
* Make parity work. Federal legislation requires that insurance companies cover mental health on par with physical health IF the policy includes it. But parity legislation has not achieved its goals because there is no agreed upon definitions of adequate mental healthcare between insurance companies and caregivers. There is also the question of whether or not insurance should include mental healthcare, but if almost half the country will need the care in a lifetime, why are we excluding it?
* Build public transitional housing: Cities are finding that building apartments and staffing them with nurses is cheaper than rolling out emergency services every time a homeless person requires care.
* Outreach, outreach, outreach: Public service campaigns encouraging corporations to give to mental health organizations would also be helpful. Billions go into cancer research every year, but only a fraction of donations go to mental illness.
What none of these efforts alone can do is remove the stigma of mental illness—the myth that instability is manifest weakness. Government and corporations can help with focus and funding embodied in efforts like the Helping Families in Mental Health Crisis Act, but they cannot engineer a more compassionate, understanding society. That part starts with each of us. If we, as a society, can succeed in treating the mentally ill, the stigma can disappear all by itself because we will have overcome the mental health challenge.
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