How Would You Fix Mental Health Care?

Susan Weinstein, J.D.

Imagine that the Congressional powers-that-be came to you and said, “We really have to fix the mental health care system. What should we do?” What would you say? Which issues would you prioritize?

Last week, 17 innocent students and teachers lost their lives after another senseless school shooting. Because the gunman apparently had a history of mental illness – as well as a number of other risk factors such as isolation, loss, and childhood trauma – many in positions of power will use this as a distraction from the myriad contributing factors not the least of which are lack of effective regulation regarding semi-automatic weapons and research into gun violence. Even though people with mental health diagnoses are more likely to be the victims of violence rather than the perpetrators, mental health advocates can use this opening in dialogue to address the ongoing issues that we see.

For the past five years, we at Care for Your Mind have been inviting you to consider a variety of perspectives about challenges and opportunities in improving access to and quality of mental health care in the U.S. What has resonated with you? Here are some salient issues from Care for Your Mind.

Integrated health care brings mental health care into the medical office, allowing for more coordination between mental and physical health care, better access to mental health care with dedicated and available mental health staff instead of lengthy waits for outside providers, and presumably reduced stigma and increased help-seeking by virtue of mental and physical health being addressed under the same roof. Integrated care also supports primary care providers – who are the first line of care in detecting, diagnosing, and treating depression – by having ready consultation from mental health professionals.

Integrated health care helps to alleviate some of the problems existing due to the shortage of qualified providers, but the shortage is exacerbated by the where providers are located across the country and the unwillingness of many to accept health insurance. Can we cultivate more providers from where they are rather than expecting professionals to relocate to where they are needed? To what extent can appropriately-trained peer support specialists provide needed assistance to people addressing mental health issues? Will tele-psychiatry alleviate some of the barriers to care that exist for people who live in rural areas and areas that lack mental health providers?

For the financial piece, are mental health providers being paid fairly? Is there really “too much paperwork” for psychiatrists so they don’t participate in the insurance system? If yes, how can we fix it? Insurance companies can impose unrealistic limits on patient care, such as with inpatient or residential care. Quality mental health care should not be available only to those with sufficient resources to pay out-of-pocket.

Access to care is meaningless if that care is not an appropriate match to the person’s needs. Let’s take teens as an example. There are approximately 8,300 child and adolescent psychiatrists in the U.S. Statistically, there are approximately 14.8 million people aged 18 and under who are likely to need mental health care. Can we expect psychiatrists to maintain an active caseload of nearly 1,800 individuals? What roles should schools play in providing mental health care? There is room for improvement in our school systems’ ability to address mental health concerns, but often not the political will or financial resources to fund sufficient mental health staff or training for teachers to support their students’ development of emotional regulation and coping strategies.

Elders face a shortage of specialized providers but, equally unnerving, most people don’t know that there is specialized mental health care available for seniors. Maternal mental health issues (e.g., postpartum depression) affect at least 1 in 9 women who are or who have recently been pregnant. To overcome barriers to care, obstetrics and pediatric practices need training on identifying and treating (or referring, in the case of pediatricians) women with mental health concerns. Veterans, too, benefit from specialized care. What can we do to better address trauma, anxiety, and depression among active servicemembers and Veterans?

Non-English speakers and those belonging to minority groups benefit from culturally- and linguistically-appropriate care. How can we support people of cultural, racial, and linguistic minorities in receiving education, mentoring, and meaningful practical experiences so they can bring new capabilities to our mental health workforce?

The research sector needs to continue to work to better understand the causes of mental illnesses so that new and more effective treatments can be developed, whether by the pharmaceutical industry or elsewhere.

Workplaces can support employees’ mental health by having easily-accessible programs, modeling good mental wellness practices, educating people about mental health issues, and making the workplace conducive to conversations about mental health. Although the benefits of bringing mental health issues into the workplace are clear, stigma continues to affect decisions to offer care and support.

Health issues – mental and otherwise – do not occur in a vacuum. Family members who receive education and act on strategies about supporting loved ones who live with mental health conditions can tip the balance toward better treatment outcomes. But providers’ misunderstanding and/or misapplication of privacy laws can interfere with constructive family involvement. We need to find a balance between the benefits and detriments of patient privacy.

Shared decision making also supports better outcomes. Are we doing enough to educate providers, people with lived experience, and families to participate in an inclusive process in making treatment decisions? Are we putting the patients first?

These are not all of the issues. While it can seem overwhelming, we believe there is also cause for hope. Knowing the problems helps us focus on possible solutions. There are no quick fixes to our mental healthcare challenges, but there are fixes. Congress, we’re here to help.

Your Turn

  • What do you believe are the priorities in improving our mental healthcare system? Why?
  • When your Congressional Representative turns to you for advice, what will you say?

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