Mental health issues have no holidays

There is enough blame to go around. Marginalized communities can often experience disparities when it comes to access to quality mental health care. Other obstacles may include geographic limitations, stigma, and the cost of treatment. These are the obvious ones, but there are others. As everywhere, racism can play a role. Often black people are fired or gaslighted. Stereotypes about certain groups result in misdiagnosis and mistrust that lead people to avoid getting help.

People living in rural areas (60 million) face many barriers to treatment (travel, inadequate broadband and internet coverage). Insurance coverage and cost can play a major role. And cultural competence, which is often lacking in health care, results in people not getting the treatment they need. Feeling understood and respected can be key to effective caregiving, which is often rooted in community and cultural practices. Language needs and translation services are often lacking, preventing quality care.

And one of the most commonly identified reasons people don’t get mental health care is stigma. While we’ve made significant progress in how we talk about mental health, stigma clearly exists, making people feel ashamed to seek help. Historically, mental health services have been viewed as “less prestigious than other health services” and receive less funding.

How can we improve the treatment gap? Although many of these barriers are deeply rooted in our health systems, they are not insurmountable. Each of these items comes at a price for people’s access to behavioral and mental health care. Some of them have simple solutions and others are much more complex.

Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), a federal law that generally prevents group health plans and health insurance issuers from offering mental health or substance use disorders (MH/SUD ) from imposing less favorable benefits. benefit limitations on those benefits other than medical/surgical benefits, is reviewed periodically to include regulations that expand coverage and address treatment limitations.

The Affordable Care Act certainly helped, but even when providers are available, many continue to operate outside the health insurance system, making them out-of-network, in part because insurers typically pay health professionals licensed mental health professionals negotiate lower rates for their services compared to physical health professionals with similar backgrounds and experience. As a result, only about 56% of psychiatrists accept commercial insurance, compared to 90% of mental health providers.

Focusing on access and lack of services, 2018 data showed that only about a quarter of the country’s needs for mental health service providers were being met. Currently, approximately 90 million people live in federally designated mental health professional shortage areas, compared to approximately fifty million people who live in similarly designated primary care shortage areas. Although rural areas often have little or no mental health care services, in urban areas, clinics and providers have long waiting lists.

The emergence of more telehealth services since the pandemic has helped somewhat, and many insurers, including Medicare and Medicaid, have expanded coverage to include telehealth options. Technology that allows different specialties to work together to create comprehensive treatment plans helps bridge the gap between healthcare organizations using different EHR (electronic health record) and ePCR (electronic patient care reporting) systems.

But the real problem is the stigma and fear that still prevents people from getting treatment. The stigma surrounding the mentally ill is not new. In fact, in ancient Greece, a “stigma” was a mark used to mark criminals or enslaved people. In the Middle Ages, mental disorders were seen as a punishment from God. And in Nazi Germany, hundreds of thousands of mentally ill people were killed or sterilized. Stigma exists in two domains: public stigma and self-stigma. We are all aware of the public stigma, the general population’s reaction to those with a mental disorder. But there is also self-stigma, which involves internalizing public stigma, where those with a mental illness turn against themselves.

Organizations such as the National Alliance on Mental Illness (NAMI), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Connecticut Legal Rights Project, Inc., along with many other organizations across the country, are constantly working to address stigma. The list of ways to fight stigma is endless, but the most common advice to eliminate it is through campaigns and education is relatively easy to follow: talking openly about mental health to educate oneself and others; correcting those who make insensitive comments; correcting others who use mental health conditions as descriptors; treating mental illness as an illness and reminding others that just as we don’t make insensitive comments about cancer, for example, we shouldn’t when it comes to mental health; and be compassionate towards those with obvious mental health problems and recognize their humanity.

These tips are fairly benign, and the awareness they will promote can help people understand that mental illness is not a character flaw or an imaginary illness, but rather an illness like any other. Raising awareness can change the way society views and responds to this complex issue. In short, public awareness reduces stigma and opens opportunities for appropriate community resources.

The harder guidance is more personal—being honest with others about seeking treatment; again, no one hesitates to say they go to the dentist. Hopefully it will be responsible and help overcome self-stigma. Mental health stigma is more than an interpersonal problem: it’s actually a health crisis. People with mental health disorders often die much earlier than they should, not from self-inflicted injuries or suicide, but from poor physical health caused by lack of exercise, poor diet, smoking and self-medication. And then there’s the damage that people who are mentally ill can do to others as they spiral. See recent events.

So even though he’s unmoved by the prejudice that those with mental health issues experience, he’s seen what can happen when those who desperately need help don’t get it. Awareness is key to understanding mental health and helping people get the help they need. Mental health awareness initiatives can help sufferers understand the symptoms and learn how the disorders manifest. When individuals recognize signs, they can seek treatment before the condition worsens and prevent serious disruptions to their lives. They are also more likely to experience fewer complications, have a successful recovery and even live longer. In addition, education and awareness make it easier for the public to identify people who may be struggling and help them get the treatment they need.

I don’t pretend for a moment to fully appreciate what the Nealy and Mangione families are feeling, let alone the senseless loss for the Thomson family. And frankly, my years as a public defender, judge, justice, commissioner, federal grievance committee member, client safety fund chair, and countless other committees where mental health issues were visible only gave me a window into struggles and ramifications for those with untreated mental illness.

Hopefully, these recent events will do more to get us to successfully focus on long-term systemic and cultural solutions to our mental health crisis than Sandy Hook did on gun control. But small gestures can have an immediate impact on people experiencing mental health issues, including helping to empower these individuals to overcome the self-stigma that often prevents them from getting treatment. And during the holidays, when everything gets amplified and life’s struggles come into focus, we can all help. happy holidays