Disparity, Not Parity, Describes Mental Health Status and Access in America Today

Paul Gionfriddo
President Mental Health America

That’s the bottom line message in a recent report, entitled Parity or Disparity: The State of Mental Health in America 2015, released by Mental Health America (MHA).

But the good news is that there are plenty of things we can do to change that – if we’re willing to change the way we approach mental illnesses in general.

MHA produced this report because we aren’t satisfied with the narrowness of the policy debate we have been having. It has been too much about public safety and post-crisis intervention, leading to a focus on inappropriate, back end, post-crisis care. These interventions occur long after mental health concerns—if identified and treated early—could be eliminated or mitigated, avoiding crises and tragedies.

Instead, we need to first call attention to the facts about mental health status and access, and second to issue a call to action that will move our thinking and our policy upstream, toward earlier interventions.

The facts

  • 42.5 million adults have a mental illness, but fewer than 18 million receive treatment
  • 6.2 million children suffer from an emotional, behavioral, or developmental  issue, but 2.4 million receive no treatment
  • One in every three children and adults forego mental health care because of costs
  • One mental health provider exists for every 790 individuals
  • 19.6 percent of people discharged from state hospitals are re-admitted within 180 days

These national statistics are hard to hear, but they cover up some huge variations in states across the nation. For example,

  • In Vermont, 57 percent of adults needing treatment receive it, but in Hawaii, only 27 percent do
  • In North Dakota, 86 percent of children needing mental health services receive them, but in Louisiana, only 40 percent do
  • In Massachusetts there is one mental health provider for every 248 residents, but Alabama has one for every 1,827 residents

Where you live matters
One surprise in our study is that the best and worst ranked states overall defy simple political categorizations. There are progressive and conservative states scattered among the best and the worst, as well as traditionally Democratic and Republican ones.

While politics may not matter, geography clearly does. The ten best states for your mental health are Massachusetts, Vermont, Maine, North Dakota, Delaware, Minnesota, Maryland, New Jersey, South Dakota, and Nebraska.

The ten worst states for your mental health are Idaho, Arkansas, Montana, Oklahoma, New Mexico, Louisiana, Washington, Nevada, Mississippi, and Arizona.

How do we close the gap?
The answer—and call to action—lies in a combination of federal and state initiatives.

  • Extend the Affordable Care Act (ACA) subsidies to those living below the poverty level
    It makes no sense that a person just above the poverty level gets a subsidy that covers up to 100 percent of the cost of a basic insurance plan, while a person just below the poverty level pays full price. This would get more people with serious mental illnesses enrolled in private health care and correct a serious flaw in the law, an unintentional consequence of the Supreme Court’s ruling that made Medicaid expansion optional instead of mandatory.
  • Expand access to Medicaid.
    An estimated 3.5 million people with mental illnesses would benefit if the states that have not yet expanded Medicaid do so this year.
  • End the practice of putting nonviolent people with mental illnesses in jails.
    People with mental illnesses account for more than half of the populations of some county jails; closing those jail beds would free up enormous local resources that could pay for community supports, including treatment.
  • Look upstream toward early identification and intervention at all levels of government.
    Failing to invest upstream carries an enormous downstream cost. Only one in every ten children with a serious mental health concern currently receives the special education services needed to succeed in school. All school children should have access to mental health screening, just as they have access to vision, dental, and hearing screening. Medicaid can now reimburse for free screening so there’s no excuse not to do it.
  • Build a larger, stronger behavioral health workforce to increase easy access to the best treatment options.
    Federal and state governments can tackle this problem by encouraging the training of traditional providers, improving provider reimbursements, including all drugs on drug formularies, and expanding the use of the peer workforce as part of clinical mental health teams.

We don’t have to stand for disparity anymore. Let’s make 2015 a year for mental health reform in America.  From the community, state, and federal levels, it is time to address mental health before stage 4, and make much needed changes to a system that is failing far too many.

Questions

  • What are the most important calls to action outlined in this post?
  • What actions will you take in 2015 to advance legislation that will support the action you identified?
  • If you look at the Parity or Disparity report, is the assessment and ranking of your state consistent with your experience?

Paul Gionfriddo was named President and CEO of Mental Health America on May 1, 2014. He has worked in a variety of health and mental-health related positions during a career spanning over thirty years. In 2013, he was appointed by HHS Secretary Kathleen Sebelius to a four-year term on the 12-member National Advisory Council to the SAMHSA Center for Mental Health Services. Prior to joining MHA, he was a consultant, speaker, and writer, and author of a popular weekly health policy blog entitled Our Health Policy Matters.

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4 comments
kimgallen
kimgallen

Early intervention and a strong workforce are vitally important, as are all of the concerns mentioned above. In terms of what actions I plan to take, I am participating in our Capitol Day events in Austin, TX. I participate on more than one Coalition. One of those is the Texas Coalition For Healthy Minds and MH America of Texas and DBSA Texas Grassroots Organization are member organizations of that Coalition. Recommendations made by the Texas Coalition For Healthy Minds include the priority of expanding the mental health and substance use disorder workforce in Texas, as an insufficient workforce creates barriers to care for all Texans, regardless of payer source. In terms of Medicaid expansion and the proposed expansion of Medicaid, The 83rd Texas Legislature and the Governor determined that the expansion of Medicaid in its current form was not right for Texas. The caseloads and associated costs have continued to rise. The ACA is expected to result in increased Medicaid caseloads and costs, even without Medicaid expansion. I plan to advocate for the expansion of Medicaid. 

Nabled
Nabled

Thanks for more details on Mental Health America's work. Are you planning to share stories from each of the states as to what's working, what needs to change, and how advocacy progresses?

KathyPowers
KathyPowers

This article comes at a good time for me when I despair of ever getting adequate mental health in the  City of Chicago. We lost another clinic and, consequently, our dear friend Jeannette Hanson. I began to think that no one cared or listened any more. Health policy does matter.