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By Peter Anderson, M.D. & Paul Grundy, M.D.

In the distant past many cultures viewed mental illness as a punishment from the gods or a demonic possession. In the less distant past and even up until the 1960s in our own country, individuals with mental health problems were confined, often un-hygienically and sometimes brutally, in state-run psychiatric facilities. As mass institutionalization gave way to more community-based mental healthcare, some of these situations clearly changed for the better.

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On the other hand, with mental health issues now being part of a cause-and-effect relationship with conditions like homelessness, incarceration, suicide, and violence, with mental health budgets being the first to go when the economy weakens, and with societal stigmas that continue to follow people seeking care, we still have a long way to go.

Some Room For Cautious Optimism

It has been estimated that somewhere between one in five to six people experience some form of mental illness over the course of a year, including bipolar disorder, schizophrenia, or depression. In many cases symptoms are relatively mild, which is often true of depression, and don’t impede day-to-day activities. Millions of people, however, suffer serious mental illness that greatly impacts their quality of life and affects their ability to function. The numbers are high, and the scope of illness is even more surprising. For example, the Diagnostic and Statistical Manual of Disorders (DSM), the American Psychiatric Association’s standard reference and classification resource, listed over 450 mental disorders in its most recent edition.

Despite the pervasive nature of mental illness in our society, mental healthcare has always been in the shadows of the larger healthcare system. It’s likely that only oral health has received less notice on our national radar. As part of this general inattention, access to mental healthcare lags behind other medical services, especially in more rural areas, and there’s also a shortage of mental health professionals when compared to other types of care providers. In addition, the cost of mental health treatment and the fact that it hasn’t traditionally been included in many health plans has created a barrier to utilization.

At least some of the optimism we mentioned stems from the increased focus on mental healthcare in the Affordable Care Act (ACA). As specifically detailed within the law, the ACA requires all insurers who sell on the Health Insurance Marketplace (also known as the exchanges) to include mental health and substance use disorder treatment benefits in their coverage packages.

While mental healthcare remains an imperfect system with unmet needs across the whole spectrum of care, improvements are coming. And even now there’s a wide range of services and resources available within the community to you and your family.

Tools, Resources & Hope

In emergency departments across the country, physicians respond to mental health crises every day, and most hospitals have a 24-hour walk-in evaluation team. The network of mental health services in the U.S. includes collaborative partnerships between private psychiatric hospitals and publicly-funded community mental health centers. There are also school-based (primary and secondary) health clinics that provide mental healthcare and substance abuse counseling.

In addition, the overall mental health network offers a large number of psychiatrists, psychologists, therapists, and clinical social workers for private and group counseling. And community-led organizations like Alcoholics Anonymous and Narcotics Anonymous, as well as nonprofit and faith-based organizations, offer other options for resources and support.

One important measure of improvement centers around the fact that in the past, mental health services never matched up with conventional medical coverage. In 2008, the Mental Health Parity and Addiction Equality Act created new regulations regarding healthcare coverage for mental health services and substance use disorder treatment. As mentioned earlier, the ACA then built on this original legislation.

Taken together, these laws represent a major shift from the minimal mental health insurance coverage of the past. The “parity” part of the legislation, which is also picked up in the ACA, means that mental health and substance abuse coverage have to be on par with the coverage offered for other medical care. Large group health plans for companies with more than 50 employees, small group health plans, and individual market plans are required to cover mental health and substance use disorder services equivalent to the level of coverage of medical and surgical benefits.

The Bridge Between Mental Health & Primary Care

Primary care providers have always known that mental health is a major public health issue and a comorbidity (a disease or condition that occurs along with the primary condition being treated) in many people seen by the primary care team. In fact, research indicates that depression as a comorbidity with chronic disease occurs in up to 40% of the population being treated.

At the same time, people with mental illness have a higher mortality rate and often die prematurely due to preventable diseases such as diabetes, cardiovascular disease, and respiratory diseases. Persons living with serious mental illness also have a higher rate of high-risk behaviors, including smoking, lack of exercise, poor nutrition, obesity, unsafe sexual behavior, alcohol consumption, and drug use.

Given this situation, what we can hope for and what we should, ultimately, expect is that the people served by our health system will receive a higher level of care and experience improved health outcomes when mental health, viewed without stigma or a sense of separation, is more fully integrated into the larger sphere of healthcare.

As we wait for that expectation to become reality, the single most important point to remember about mental health services is that like other aspects of our health, it’s best to be proactive. Don’t wait until there’s a crisis to reach out for help. The sooner you or a loved one can find the services or support needed—for any mental or substance use disorder—the better. And the less likely you’ll be to need more intensive levels of care down the road.

This article is an excerpt from Chapter 9: Mental Health: Where We’ve Been and Where We’re Going of “Lost and Found: A Consumer’s Guide to Healthcare” by Peter Anderson, M.D. and Paul Grundy, M.D. The complete book can be found at http://hubs.ly/H02kfl-0.


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