How is mental health care failing American patients?


According to the National Institute of Mental Health (NIMH), about 9.8 million adults (or 4 percent of all adults) over the age of 18 years suffered a serious mental illness in 2015. A serious mental illness is one that affects a patient’s daily functioning. Considering all mental illness in adults in the same time period, 43.4 million adults (or 17.9 percent) who met the criteria for a mental illness diagnosis. In children, approximately 1 out of every 5 suffered a serious, debilitating mental illness at some point in their lives.

Looking at the high number of people suffering from these disorders, it should be expected that there was a strong system in place to treat these illnesses. But, in fact, this is far from the reality. Getting a help for a patient with a mental illness is often an exercise in futility. Being a family doctor, I see patients with all kinds of diseases. When a patient has a disease where more specialized medical care is needed, I refer the patient to an appropriate specialist. But with mental diseases, this is often an impossible feat.

How is mental health care failing American patients?

  • From their first encounter with the health care system, patients with mental illnesses are stigmatized. Their health cover is different from their mental health coverage, as if a different importance is given to physical versus mental ailments. Patients already have a hard enough time admitting there is a mental problem. But the system only makes it harder by throwing other obstacles in the way.
  • Many specialists don’t accept certain insurances, such as Medicaid. It is not because they are practicing biased medicine but rather they were losing money treating patients with these insurances. No business can survive at a loss. Now that we are in mental health crisis mode, it is time for insurers to step up and expand their panels and reimburse these specialists fairly.
  • Counseling services are often not covered. Many patients do not need more expensive therapies, such as medications. However, hey cannot afford to see these other providers. Coverage should be expanded to include psychologists and therapists.
  • Mental illness is often treated as less important than physical illness. However, many physical diseases have worse clinical outcomes when mental illnesses co-exist. A good example is recent evidence that shows patients suffering heart attacks have a higher mortality rate when they have untreated depression as well.
  • There are not many resources for emergencies. If a person is having chest pain, I think almost everyone knows to call 9-1-1. But what should be done with the person is borderline suicidal? Yes, there are crisis intervention numbers to call, but these are often just to decide if a patient needs emergency “commitment” to a mental health unit in the hospital. Most people are lost on how to help someone suffering from a mental disorder.
  • Access to mental health services is restricted. You must the right insurance or the ability to pay out-of-pocket to be treated. Even then the wait may be months when you are struggling to keep your head above the water. For children, many times this hurdle is even higher.

While the health care system fails patients with mental illnesses, perhaps society at large is the bigger failure. People often crack jokes about mental diseases, saying someone is acting schizophrenic or something similar. And people laugh and think it is funny. Would anyone make a joke at the cost of a patient dying from cancer or suffering from an infectious disease? No, because it is not politically correct to do so.

We need to understand that mental illnesses are diseases the same as physical ones and just as serious for those afflicted with them. Until we can accept that simple fact, people will continue to hide their disorder in shame and silence. Maybe then, we would see fewer national tragedies like Columbine and Sandy Hook.

Linda Girgis is a family physician who blogs at Dr. Linda.

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