Why Accessing Mental Health Care is an Enigma

Have you ever found yourself in need of mental health resources? Possibly for yourself or a family member? Or even for a friend or a patient? If you have, chances are you have struggled to find the right care. The first hurdle is identifying the type of care needed. Once you have that down, you probably struggled to find a provider, especially one that takes your insurance.

If you have had this experience, you are not alone. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), upwards of 57 percent of individuals with mental health needs have not found access to appropriate levels of care.¹

This issue is becoming apparent as mental health becomes less stigmatized and more people see the benefits of this type of care. Although the stigma of mental health in the general public has reduced considerably in the last decade, it remains high in the healthcare system. To summarize a very lengthy explanation of the situation, the President and CEO of the California Health Care Foundation says it best: “For too long, the health care system has treated mental health concerns as a second-tier issue.”²

Choosing the Right Level of Care

For the sake of brevity, let’s boil all of this down to two primary issues. First the responsibility for choosing the right provider or level of care is almost always put on the patient - or worst yet, the insurance company - rather than trained professionals equipped to diagnose and prescribe a course of treatment. No other place in health care is it acceptable to assume that the patient will be educated enough to make these decisions.

For example, imagine a patient experiencing significant headaches. Think of all of the possible causes from dehydration to life changing neurological issues. If we treat this issue as we treat mental health issues, we would leave it to the patient to determine whether they should take a low dose of aspirin or seek out a neurological specialist. Of course, this is seen as unacceptable and therefore the recommendation would be to first begin with the patient’s primary care physician. From there, this expert would assess the appropriate treatment or referral.

Choosing the Right Mental Health Professional

This leads to the second problem. Imagine there is a shortage of primary physicians on par with the current situation we face with mental health. In this case, the patient would have to wait weeks, if not months, to see their primary care physician. They might even be told by their insurance company that there are no primary care providers in their network.  That is the situation for mental health. This is particularly true for Californians as we rank 25^th in the nation for mental health access.³

Integrating Behavioral Health into Primary Health

There is no silver bullet solution to these problems but the most hopeful pathway we have today is called “behavioral health integration.” Programs and policies which encourage and promote behavioral health integration are currently under development. Although there are many different models, the basic idea is that physical healthcare locations add and integrate behavioral health professionals and resources.⁴

For example, a primary care practice could add a licensed mental health provider to work within the care team. They can also add mental health screening tools and follow-up referral resources. Whenever this is done, the overall cost of the person’s care goes down and the quality of their care improves significantly.⁵ The other benefit is the use of screening tools. These additions to primary care practice help the care team identify potential mental health needs before the individual is in crisis and desperately researching mental health options on their own.  

Why Are Behavioral Health Integration Models Not the Rule in Health Care Yet?

That’s a tough one to answer. While this is a known practice and more primary care facilities are adopting this integrative practice model, integration takes significant capital investment to launch and the current healthcare reimbursement models do not reach a breakeven point for these added resources.

Therefore, there is more work to be done in training additional mental health providers to increase access as well as supporting behavioral health integration and parity policies. There has been good work done on a policy level to enhance mental health access, but we still have a long way to go before mental health achieves parity with physical health practice.

References:

1. Substance Abuse and Mental Health Services Administration (SAMHSA). (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey and Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52).
2. California Health Care Foundation (2020). Health Care Priorities and Experiences of California Residents: Findings from California Health Policy Survey. Retrieved from https://www.chcf.org/wp-content/uploads/2020/02/HealthCarePrioritiesExperiencesCAResidentsFindingsHealthPolicySurvey2020.pdf
3. Mental Health America (2017). 2017 State of mental health in America – Access to care data. Retrieve February 2020 from https://www.mhanational.org/issues/2017-state-mental-health-america-access-care-data
4. Substance Abuse and Mental Health Adminstration (2020). SAMSHA-HRSA Center for Integrated Health Solutions. Retrived February 2020 from: https://www.integration.samhsa.gov/integrated-care-models/list
5. Asarnow JR, Rozenman M, Wiblin J, Zeltzer L. Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis. JAMA Pediatr. 2015;169(10):929–937. doi:10.1001/jamapediatrics.2015.114

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