Access to Care

Ron ManderscheidRon Manderscheid, Ph.D.
Executive Director, NACBHDD

If you or a family member needed care today for a mental health or substance use condition, would you be able to get it? Mental health and substance use conditions, like depression or inappropriate use of alcohol, are real, treatable health problems. As with other health problems (like diabetes, high blood pressure, or heart disease), people with mental or substance use conditions can lead healthy, productive lives when the health problem is diagnosed and treated. When identified and treated early, the severity and impact of these health issues, including damaging consequences to both the person being treated and her or his family, can be reduced. That’s why the process of getting care—what we refer to as gaining access—is critically important.

 

Access to care can help prevent, delay, and treat mood disorders, other mental health conditions, and co-occurring illnesses, such as substance use. Having access to mental health care services can be the factor that determines whether a person is able to achieve wellness or succumb to despair, restore a healthy relationship or divide a family, keep a job or become dependent on family or government subsidy. Having access to mental health care services affects most if not all of us at some point in our lives and that’s what makes this topic worthy of being the inaugural blog post on Care for Your Mind.

Over the past few years, a growing number of lawmakers have recognized that mental health is part of overall health. They decided it was time for both public and private health plans to

  • End annual and lifetime limits on behavioral health coverage
  • Make out-of-pocket costs for mental health and substance use care no more expensive than for medical care
  • Stop penalizing people with existing mental or substance use conditions and stop restricting them from getting health coverage in the first place.

Recognition became reality when Congress enacted the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to assure that people with mental health or substance use problems are not denied health care based solely on that diagnosis. In this realm, parity means assuring access to health care services for mental health conditions on par with physical health conditions. This commitment to parity for mental health and substance use conditions is being implemented across the nation as the preventive and integrated care provisions of the Affordable Care Act (ACA) take effect.

At last, mental and addictive health are beginning to be treated as part of overall health. And it’s about time! After all, these conditions are among the top causes of disability in the US and worldwide. They take a toll on families, communities, the education system, the workplace, and the economy to a startling degree.

Facts, Just the Facts
The numbers tell the story.

  • Mental disorders affect 1 in 4 US adults (45.6 million) and children/youth (15.6 million)
  • Mood disorders affect 20.9 million American adults age 18 and older (that’s 9.5% of the population), and are more prevalent in women than in men, affecting girls age 12 to 15 at triple the rate as in women (15.2% for girls and 5.1% for women)
  • As many as 8 million adults age 18 and over have both a mental and a substance use condition: rates of substance use disorders among people with mood disorders are double those of other adults. 

These data point out a cold, hard truth: access to care is critical for millions of people of all ages. Both health and life can be affected for better or for worse by the ready availability of care. However, the realities of access are that fewer than 40% of adults and youth with mental health conditions ever get any mental health services fewer than 7% of adults with co-occurring mental and substance use disorders get treatment for both; 32.5% receive only mental health care and 4% get only substance use treatment.

The Importance of Access to Care
When access to care for any chronic health problem, including mental health conditions and substance use disorders, is—or care for any other chronic health problem—is denied or otherwise unavailable, prevention and early intervention are all but impossible. Symptoms go unmanaged and get worse. Without diagnosis and treatment, people get sicker faster. For many people with treatable mental or substance use problems, the result can be a downward spiral of increasing disability. Many experience additional physical or behavioral health problems that also may go untreated. Without diagnosis and treatment, the lives of people with mental or substance use conditions may be cut short by as many as 25 years. That’s a lot of living to lose! But the toll doesn’t stop there: this downward spiral often includes lost education, lost employment, broken families, and, too often, lives lost to suicide.

In contrast, available and accessible care is based on the recognition that care for mental health and substance use problems is part of overall health care, and that these conditions are real and treatable. Addressing them as treatable medical conditions can reduce the negative perceptions — or stigma — associated with mental health and substance abuse conditions, much like the change in how the public looks at cancer. That’s good public health policy.

Accessible mental health and substance use care is also good personal health policy. Access to evaluation and diagnosis can help prevent or delay the onset of these conditions. Access to early intervention can move people with diagnosed mood disorders and other mental health conditions toward health and recovery. Related health problems, such as substance use or alcoholism, heart disease, and HIV, also can be delayed or prevented altogether. That’s not only for medical reasons, but also because access to mental health and substance use care as part of overall health care involves creating links to all kinds of helpful services and supports that encourage community engagement and integration. And those services and supports can help boost protective factors that promote ongoing mental and physical health and reduce risk factors for the recurrence of mental or other health problems.

Ongoing access yields an opportunity for patients and health care professionals to examine how well care and treatment are going and to make collaborative decisions about needed changes. Ultimately, ongoing access makes the promise of recovery a reality.

Editor’s Note:
Ron’s next contribution to Care for Your Mind explores major obstacles to access. The third explains how the Affordable Care Act helps improve access to mental health care for millions of Americans, including you. Finding out that you or a family member has a mental health or substance use condition is only the beginning. Make comments, ask questions, and continue to learn about mental health care on Care for Your Mind.

Facebook Comments

3 comments
Stephen Bonin
Stephen Bonin

Celeste: This passage toward the end of your post resonates with me:

We are experts in what we have lived and are living and have much to

offer in being a part of the reduction in Medicaid spending. I am praying

that the state recognizes this gold mine. I just heard two weeks ago this is

going to be a reality. A serious concern I have though is the ratio of how the money is disbursed. We need funds for peer inclusion and have been ignored for to long on what it is we bring to mental health wellness.

YES! WE ARE EXPERTS! i am so happy to be on this panel with articulate people who, as you say, are the ones deserving of being heard. Your post motivates me to keep on doing what I'm doing--communicating with writing, and picking up trash and recycling, with the CONVICTION that I will be noticed and heard. We on this panel most likely do not have money; but we can be resourceful with our words and our good deeds.

Stephen Bonin
Stephen Bonin

Ron's article is relevant. At age 53, have a communications degree, and having written for newspapers for many years, I see fault in our local newspaper. We are a city of 25,000; this newspaper goes out county-wide as well. Too much coverage of school-age youth to the sacrifice of coverage of problems and how we can solve them.

I am healthy, though not able to to be in the workforce. Through prayer and thought, I have decided to pick up trash and recycling and let many cars see me. The bottles, cans, and more I pick up speak to me of people needing to feel a sense of power. Littering is a quick release.

More people need to be made aware of their depressive issues. I believe that by going out three days a week currently, for about two to three hours at a time, I can exercise for my health, and do a good deed for our community. I believe there will come a day that people will pause to talk with me; I will readily talk about my journey with mental illness since 1979.

Good things will follow--for me, our community, and these drivers.

Celeste T
Celeste T

"Ongoing access yields an opportunity for patients and health care professionals to examine how well care and treatment are going and to make collaborative decisions about needed changes. Ultimately, ongoing access makes the promise of recovery a reality."


Without attending to both my mental health condition and substance abuse simultaneously I wouldn't be on the path towards recovery I am on today.  20 years of serious drinking becoming an expert at it, then making my own decision to quit left me vulnerable to the manic depression I had been diagnosed with in 1975.  No one told me it doesn't go away and the system back then was you are ok now and I left MH public mental health care only to slowly pick up the SA.  Now with 18 years of sobriety through Education, I find being an informed consumer makes or breaks it.  Keeping in mind I owned the desire to quit but only after attending MICA groups did I have of chance to achieve sobriety. 

Participation in a Continuing Day Program in 1995 they supported MICA as did the housing program I was in and the peer support I got from our social club which was referred to as only being a place that offers smoking and rocking and was closed am I where I am today.  Talk about the ultimate insult and stigma and disrespect of me and all the peers in our community.  It cut deep into our hearts but we are persevering in spite of those types of attitudes and will survive and keep moving forward in our community. 

"Access" to these providers of services fell into place for me. My faith in something greater than me who I chose to call God sure worked in my favor.    

Is there need for improvement, there is, and always will be but I see much work being done in our community with the exception of one provider who unfortunately insists on being a silo.

We do need more housing and money for services from Medicaid.  Our hospital runs in the red in regards to mental health. The lines to get into the county public health clinic is long.  The length of time to get into a housing program is long.

With Medicaid redesign there will be reinvestment back into mental health system for the providers but especially important is the need funding for peer inclusion in the mental health treatment process, not at minimum wages either.  We are experts in what we have lived and are living and have much to offer in being a part of the reduction in Medicaid spending.  I am praying that the state recognizes this gold mine. I just heard two weeks ago this is going to be a reality. A serious concern I have though is the ratio of how the money is disbursed.  We need funds for peer inclusion and have been ignored for to long on what it is we bring to mental health wellness.

Trackbacks

  1. […] the May 1 “Access to Care” post, we asked, “If you or a family member needed care today for a mental health or substance use […]

  2. […] and Anticipating Impact Last week, Ron Manderscheid pointed out  the possible consequences of decreased access to mental health services: worsening of symptoms, an […]

  3. […] inaugural post Access to Care was written by Ron Manderscheid, PhD.  He’s the Executive Director of the National […]