America’s mental healthcare system is in desperate need of repair. Over 60 million individuals in the United States struggle with mental health conditions. Of these 60 million children and adults, almost 50% of them live with an untreated mental illness. American’s living with untreated mental illness face disability, unemployment, incarceration, substance abuse and addiction, homelessness, and suicide.

Statistics on Treatment of Mental Illness

Untreated mental illness is an enormous cost to America, a 100 billion dollar expense. Out of the top 10 leading causes of disability, four of them are mental disorders. Depression is the most common disability, worldwide, for individuals under the age of 60. 

The most common treatment options for severe mental illnesses are between 70% and 90% effective. If we ensure the provision of all Americans with mental health care, we could reduce the number of individuals on disability due to mental illness and save tax dollars. 

ACA: The Affordable Care Act of 2010

Congress passed the Affordable Care Act in 2010. The aim was to improve the quality and access of healthcare for Americans. This reform law increased insurance coverage for uninsured U.S. citizens. Provisions under this law meet AMA policy and aim to create a better healthcare system for all. 

Changes in Healthcare 

1) Expanded Medicaid eligibility to income limits at 138% of the poverty level.

2) 38 States and D.C. have expanded healthcare and implemented ACA policies. 

3) Reduced out-of-pocket spending.

4) Encouraged citizens to follow up on medications and seek regular healthcare services. 

5) Increased the age for dependents to remain on their guardian’s health plan to 26 years old. 

Shortcomings in Healthcare

1) The number of company-sponsored health plans decreased. 

2) The act had little effect on America’s mental healthcare system. 

3) To offset the increased cost for insurance companies, provider networks shrunk.

Five Factors Determine Accessibility

Despite the successful treatment options for mental health conditions, 20% of adults living with mental health conditions in the U.S. are not receiving or seeking care. Studies indicate that individuals suffering from high levels of psychological distress are more likely to forgo medical treatment due to the following barriers. 

Approachability 

Approachability in terms of mental health care is the individual’s ability to recognize that they need help and the ease of seeking care. Unfortunately, most individuals living in America would be unable to tell that they needed mental health care. Unlike physical wellness visits, most individuals do not have regular mental wellness check-ins. 

Mental health challenges make it more difficult to find, schedule, and follow through with a care plan. Lethargy, confusion, crippling sadness, anxiety, and fear are all symptoms of mental health conditions that may prevent an individual from obtaining care. 

Availability 

While approachability deals with recognition and ease of seeking care, availability deals with the ability to obtain care. 37-45% of Americans live in a region with a shortage of mental health professionals. Rural America especially lacks the mental health professionals needed to assist the population. 

Regions where mental health care is readily available may have insurance issues. The providers may not accept insurance or may be considered out-of-network. These issues contribute to the affordability barrier. 

Affordability 

50% of the individuals living with untreated mental health conditions in the United States blame affordability as the top barrier to treatment. Lack of insurance coverage for mental health conditions, high out-of-pocket costs and insurance premiums, and the inability to pay affect the affordability factor. 

The gap between the number of barriers to mental health care compared to standard health care is wider in the United States than in any other comparable nation. 

Acceptability

The stigma attached to mental illness affects the ability of Americans to accept that they need mental health care. Too often, physicians attempt to treat the physical symptoms of mental illness without realizing or believing that the underlying issue is a mental health condition. 

Individuals struggling with mental health challenges often fear the stigma perceived to be attached to mental illness. They find it difficult to accept that they need help because they do not want a label. 

Appropriateness

Appropriateness deals with the individual’s ability to participate in treatment and engage with mental health professionals. In some cases, individuals with mental health challenges are unsure where to find help. As a result, they may turn to their regular physician for advice. This situation is more likely in regions with a shortage of mental health providers. 

There are 357 disorders listed in the DSM-5. Many of these disorders have overlapping symptoms and are difficult to differentiate. The number of conditions with similar symptoms makes it difficult to tell which mental health conditons(s) plague the individual. Since many Americans are unsure of which symptoms to discuss or are embarrassed to discuss private symptoms, the risk of being incorrectly diagnosed is notable. Individuals with severe mental health conditions often carry three or more diagnoses. 

Oppression and Mental Health Care

In 2008, Congress enacted the Mental Health Parity and Addictions Equity Act. However, marginalized Americans still face more barriers to healthcare. The social stigma attached to mental illness prevents many Americans, especially those that live in rural areas, from seeking assistance with mental health. 

Stigma Surrounding Mental Illness 

Two forms of stigma surround mental illness, the public, and the self. Public stigma pertains to stereotypes, prejudices, and discriminations society has towards individuals with mental illness. Self-stigma describes the stereotypes, prejudices, and discriminations we believe about ourselves.

Although 76% of Americans believe that mental health is equally important compared to physical health, our general beliefs do not match. Our brain is a muscle like our heart, but we treat the issues that affect the brain very differently from the ones that affect the heart. We also judge and criticize individuals with mental illness more than individuals with physical conditions like heart disease. 

Understanding how stigma prevents treatment and worsens symptoms can motivate us to destigmatize mental illness. To destigmatize mental illness, we must inform ourselves and change the story. 

Examples of Public Stigma 

A common stereotype associated with individuals with mental illness is that they are incapable. If an individual with mental illness has an interview with a potential employer, they may disclose that they have bipolar disorder. This disclosure could raise prejudice in the employer. The employer may believe that the individual with bipolar disorder will be unreliable and incapable of the job. Since the employer has this prejudice, they may write off the individual and hire another in their place, discriminating against those with mental illness. 

Examples of Self Stigma

From the self-stigma perspective, individuals with bipolar disorder may feel their ups and downs and believe that they make them incapable of dependability (self-stereotyping). This belief lowers their self-esteem and plants the seeds of self-doubt (prejudice against self). The individual does not believe they are capable of the job. They may decide to cancel the interview (self prejudice). It is important to note that self-stigma often feeds off of public stigma. 

Systematic Disadvantages of Marginalized People

African Americans, American Indians, Alaskan Natives, and Hispanic Americans are all racial groups historically and currently discriminated against in America. This discrimination affects the group’s overall mental health during discrimination and in the future. 

These groups of marginalized people face all of the barriers to mental health care listed above and more. To begin with, 68% of adult psychiatrists active in the United States are white. Another 20% are Asian. That leaves 12% of psychiatrists in the United States from a marginalized group. Consider the numbers and note that when a white female visits a psychologist, there is a 68% chance that the psychologist will look like her and understand her background. For the discriminated groups, there is less than a 12% chance that the psychologist will look like them and understand their background. Understandably, this could breed fear, distrust, and contempt. 

Additional Barriers Marginalized Individuals Face

1) America’s history of abuse and neglect within the healthcare system towards discriminated populations. 

2) Hispanic Americans, American Indians, and Alaskan Natives are 2.5 times as likely to be uninsured. 

3) Marginalized groups have been economically disenfranchised throughout history resulting in less generational wealth and increased risk of unaffordable costs. 

4) Mental healthcare is more likely inaccessible for marginalized groups due to geographics, cost, and associated stigmas. 

The National Alliance on Mental Illness (NAMI) Recommendations

NAMI recommends that insurers and Medicaid management improve coverage in the following ways to meet and exceed federal parity law.

1) Add incentives and increase reimbursement rates for mental health visits. 

2) Actively work to reduce barriers to mental health care. 

3) Expand essential models, such as the Collaborative Care Model. 

4) Expand the network through recruiting and contracting MH and SUD facilities and providers.

5) Allow healthcare professionals with the necessary training to prescribe mental health medications.