About one in five US adults cannot afford the mental healthcare they need, a grim reality exacerbated by COVID-19 and the ensuing new norms.
During the onset of the global pandemic last year, about four out of 10 adults had reported symptoms of depression and anxiety, a 400% increase from 2019. Out of this number, 8.3 million had a severe mental illness during this period, with half of them receiving no treatment.
Fractured Mental Healthcare System
America’s fractured mental healthcare system is caused by multiple factors, ranging from insurance companies denying claims, widespread ignorance and discrimination against people with mental health issues, and lack of enforcement of the federal parity law.
Historically, health insurance companies have provided better coverage for physical illnesses than mental health issues. Further complicating the situation is the widespread misconception that depression, anxiety, psychosis, and the likes are “abstract” and “unknown” conditions that we can’t do anything about them–unlike cancer, heart disease, and other “more obvious illnesses.”
But in reality, nowadays, we have therapies, medications, and other science-backed methods that can help people with mental health issues. Nonetheless, the broken and highly segmented mental healthcare system makes it hard, if not impossible, for some people to access the treatments they need.
Lack of Awareness and Enforcement
In 2008, the government passed the mental health federal parity law to require insurance companies to provide coverage for mental health, substance use disorders, and behavioral health the same way they provide coverage for physical illnesses. Simply put, there should be no distinction between them–for example, if the copay for a surgical visit is $30, the same amount should also apply to a mental health visit.
While the federal parity law is a massive step towards achieving a solid mental healthcare system, two main factors prevent it from delivering a genuine change: lack of enforcement and awareness. In fact, a 2014 survey conducted by the American Psychological Association showed that around 90% of Americans were not familiar with this law.
Cracks in Our Mental Healthcare System
In May 2021, I was invited to join a virtual event discussion attended by fellow mental healthcare experts and advocates Tom Insel, MD, Arthur Evans Jr, Ph.D., and Pooja Mehta.
The main topic of our discussion is the fractured mental healthcare system that leaves millions of Americans with debilitating anxiety, substance use disorder, depression, etc., to suffer for years without receiving treatments and help.
Below, I compiled the highlights of our discussion:
- There are access points to quality mental health care, but the problem is that most people don’t know how to access them. Hence, we need to educate individuals and help them understand that they can have more control over their psychological health.
- The mental healthcare system should adapt to the changes and trends caused by COVID-19, such as the growing popularity of telehealth consultation. This should also mean that the patient’s insurance must cover mental telehealth.
- Our broken system criminalizes symptoms of severe mental illnesses (e.g., putting people in jail) instead of helping them lead a happy, productive life.
- An effective mental healthcare system is an all-encompassing system. Healthcare is like a repair shop–in a sense that it accounts for 10% of a healthy mental state–but the remaining 90% accounts for the environment, such as the school, community, family unit, etc.
- Our mental healthcare system is sick-focused, meaning everything is built around the crisis. Unfortunately, this approach is counterproductive and way more expensive compared to proactive and preventive measures. (Based on my personal experience, “visible” symptoms of mental and psychological problems are just a culmination of an issue that has been brewing for years.)
- The mental healthcare system should not be limited to the medical field; it must also encompass our social, environmental, and political landscape to deliver genuine change.
- Denying coverage and discriminating against people with mental health issues are actually civil rights violations.
- Digital media can educate people with anxiety, depression, and substance use disorders and give them more control over their psychological health.
Repairing the Cracks
We need public and private efforts–combined with social, political, and environmental changes– to repair the cracks in our broken, highly segmented mental healthcare system.
Furthermore, we need to invest more in treatments and systems to help people lead happier, more productive lives. After all, “healthy citizens are the greatest asset any country can have,” to quote Winston Churchill.