Mental Health in the U.S.

BY STEPHEN JOSEPH – Mental health is currently a controversial issue in the United States. Mental health awareness has certainly increased over the past several years, especially after the tragic series of mass shootings. The popular sentiment over the need for professional mental health treatment is also supported by statistical evidence. The National Council for Behavioral Health states that 46.4% of adults will experience a mental illness during their lifetime. According to the CDC’s National Center for Health Statistics, the annual U.S. suicide rate increased by 24% between 1999 and 2014. However, only 41% of the people who had a mental disorder in the past year received professional healthcare or other services. This is in comparison to over 90% of people receiving treatment for physical health issues. So, why is there such a large discrepancy in the number of people experiencing mental health issues versus those actually receiving care? 

Increased Awareness

There is an increase in mental health cases in the U.S. partly because of increased mental health awareness. The stigma surrounding mental health has decreased considerably in the past few years. Increased access to mental health tools in school and general acceptance in popular culture have led more people to pay more attention to their mental health, not just their physical health. However, the medical field is not prepared for this influx of patients.

Lack of Psychiatrists

According to a 2016 Health Affairs report, more than half of U.S. counties have no psychiatrists. The U.S. Department of Health and Human Services reports that 111 million people live in these underserved areas. The lack of psychiatrists can largely be attributed to the stigma of mental health and the low pay of the psychiatric specialty. The AAMC and individual medical schools are taking steps to increase recruitment for psychiatry, but the process will be very gradual. However, there are potential problems even if someone is able to find a psychiatrist.

Insurance Problems

Only about 55% of psychiatrists take some form of insurance, whether private or government-sponsored. This is in comparison to the average of 89% for all healthcare professionals. This is because psychiatrists often receive lower reimbursement when working directly with an insurance company. If the psychiatrist does not take insurance, the patient must pay out-of-pocket for the expenses and then file a claim with their insurance company. If their claim is approved, then they will be reimbursed for their visit. However, insurance companies often exploit a concept called “medical necessity” to reject these claims. If the patient’s mental health visit is not deemed “medically necessary” by the insurance company’s own doctor, the patient will not be reimbursed. This presents an obvious conflict of interest for insurance companies since higher rejection rates mean higher profits.

Legislation

The U.S. federal government tried to address this issue with the 2008 Mental Health Parity and Addiction Equity Act, making it illegal for insurance companies to place more quantitative limits on mental healthcare than physical healthcare. This meant no higher copays, no separate deductibles, and no lower limit on visits to the doctor for mental health reasons. While the law theoretically improves the insurance problems, it is poorly enforced due to a lack of sufficient funding from the U.S. Department of Health and Human Services, who oversees health insurance plans. While there is no easy solution, the first steps would involve adequate funding from the regulatory agencies for health insurance plans.

Editor: Jane Chang

Photography Source: https://www.forbes.com/sites/brucejapsen/2017/06/06/psychiatrist-shortage-intensifies/#39261b995d96