Tragic high-profile suicides have once again brought forward our failure to properly care for the mental health of Americans. Though nearly 20% of American adults and 23% of children live with mental health issues, 56% of people facing mental health challenges do not receive treatment due to a shortage of mental health workers, poor insurance coverage, and the stigma surrounding mental illness. In New York City, of the 239,000 adults who suffer from a serious mental illness, 90,000 receive no treatment whatsoever.
Recent reports have suggested that suicide in America has risen by almost 25% since 1999, with half of all states showing an increase in excess of 30%. More than half of individuals who die from suicide have not been diagnosed with mental health issues, but it is estimated that between 30% and 70% of these people suffered from depression or bipolar disorder, indicating that many people live life with undiagnosed illness.
American youth face particularly low levels of treatment, with 76% receiving insufficient or no treatment, despite nearly half of children having diagnosable mental illnesses at some point before turning 18. Facing mental health issues at such a young age puts these children at a much higher risk for academic failure, substance abuse, and clashes with the juvenile justice system.
We can do so much more to help those coping with mental health issues. By ensuring that Americans’ mental health is taken just as seriously as their physical health by providers and insurance companies, by making sure that those who need treatment receive it, and by combatting the social stigma of mental illness, we can be a healthier and stronger nation overall.
Health Insurance Parity
Thanks to the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Affordable Care Act (ACA), insurance coverage for behavioral and mental health care services is required to be equivalent to the coverage that insurers provide for physical health care services. This is an important step forward in assuring that individuals have access to care. Unfortunately, access to care does not necessitate that the care is affordable or of high quality.
Insurance companies are twice as likely to deny coverage for mental health care as they are for general health services, and behavioral care is much more likely to be provided out-of-network , and thus be cost prohibitive. Insurers pay primary care providers 20% more than behavioral care specialists. Insurance companies must be held accountable for their lack of adherence to the law, and their negligence in assuring that customers receive quality care. It should be easier for patients who have had their rights violated to file complaints, and, states should opt for Medicaid coverage that robustly covers mental health care for at-risk populations.
Assisted outpatient treatment
Assisted outpatient treatment (AOT) is a highly useful tool in combating the mental deterioration of individuals in psychiatric crisis, which is key to supporting Americans with serious mental illnesses and their families. AOT is court-ordered outpatient treatment for those who have consistently refused to comply with medical guidance, and requires medication compliance while allowing individuals to remain in their communities. Studies have shown that AOT reduces the incidence and duration of hospitalization, homelessness, arrest and incarcerations, victimization, and violent episodes.
New York has led the way on AOT, implementing it through Kendra’s Law in 1999. In addition to allowing courts to instruct seriously mentally ill individuals to accept care while living independently or with family, the law also allows courts to mandate that the mental health system provide this care, so that patients and their caretakers aren’t left to fend for themselves. In New York, Medicaid Managed Care is another resource that covers the cost of treatment for those who need it.
Not all states have such a broad AOT policy, however. Only 44 states have outpatient commitment laws of some sort, and each varies in the level of funding that Medicare and Medicaid provide. Assisted outpatient treatment is a valuable treatment option, and should be the standard in all states, with all costs covered by insurance. AOT has been shown to successfully in preventing relapse in the seriously mentally ill and should be an option for every community in the country.
Changing attitudes about mental health
A mere quarter of people who live with mental health issues feel that other people are caring or sympathetic toward their condition, indicating that a significant majority of Americans with mental illnesses feel unsupported and misunderstood in their struggle. The stigma around mental illness in our society prevents many people from seeking the treatment they need — we must fight to overcome this bias.
This fight begins by partnering with our primary care providers to normalize mental health issues in the context of typical physical exams. Health care providers must take mental health just as seriously as physical health when it comes to patient care, implementing behavioral health checks as part of regular exams. This has the potential to drastically cut down on undiagnosed cases of mental illness, as well as familiarize patients with how common and manageable mental health issues can be.
As a nation, and especially in Washington, we most stop drawing a false link between gun violence and mental health. Not only does this argument fail to address the key causes of the gun violence epidemic but it also further stigmatizes mental health in our society. The criminalization of mental health has long plagued our justice system. A 2016 report found that nearly ten times more individuals with severe psychiatric illnesses were incarcerated in prisons rather than housed in state hospitals. Courts must prioritize treatment and rehabilitation over prison for low-level, nonviolent offenders. Excessively penalizing people with mental health issues is simply not the answer.
While policies and legislation can go far in helping Americans pursue mental health, there is simply no replacement for compassion and empathy. We have a responsibility to care for one another and seek long-term solutions for people who face difficult mental health challenges. As we all work to overcome the stigma surrounding mental illness, we must pursue more consistent treatment regimes and ensure the enforcement of laws guaranteeing comprehensive, affordable healthcare coverage for mental health. We can build a country that is more empathetic towards mental illness, and more committed to supporting every person in this country who faces mental health challenges.