Despite the fact that over 6 percent of the US population suffers from depression and another 1.5 percent suffers anxiety, mental healthcare is still very stigmatized. Many patients do not want to accept the fact that they are experiencing one of these or other conditions. In fact, many patients tell me they “are not crazy” when I suggest certain medications or referring them to a psychiatrist. Combine that with the fact medical services for these patients is often difficult to get and there is a true mental healthcare crisis in the US.
Many patients who are afflicted with these disorders are told by family or friends just to “get over it” or “deal with it”. Unfortunately, these are disease just like diabetes and hypertension and need real treatment just like these other maladies. No one tells a diabetic to just relax. The fact that mental health disorders are not seen to be real diseases by many makes people reluctant to seek medical attention. We need to raise awareness that patients do not possess mind control over these diseases.
There is a long continuum in many mental health disorders. For example, a patient may have mild depression that does not affect their life to a great degree but on the other end of the spectrum, a patient may be catatonic and not functioning to any degree on their own. Expectations that a patient with a certain diagnosis behaves in a certain fashion must be torn down and the diversity revealed. Additionally, words such as “crazy” must never be used in the medical setting, even behind the scenes.
Now, we are also seeing a critical access problem into the mental healthcare system. To start, many health insurance companies cover mental health diseases differently than other medical diseases. They have separate departments and phone numbers which makes it difficult for patients to know how to seek medical care under their plans. Why do they differentiate mental health disorders from others? In my mind, that seems to stigmatize patients enduring mental health problems right off the bat. These are real medical diseases that patients cannot control or just wish away.
In my practice, I sometimes need to refer patients to a psychiatrist and/or psychologist. However, this is often a near impossible task. There is usually a several month waiting period and often we simply cannot find any doctors who accept a patient’s insurance plan. The patient is left to agonize while waiting. I am left to care for these patients and do the best I can. But, this is not my specialty and occasionally patients need more that I can offer. What about the suicidal patient? They go to the ER where they are evaluated and treated after which they return to me, still waiting to get to the mental healthcare professional. This is simply unacceptable. No one would tell a patient with chest pain they need to wait 6 months to see the cardiologist.
Many psychiatrists dropped out of the third-party system all together and only accept payment directly from patients. And who can blame them? No industry can continue to function at a loss, which was happening due to poor reimbursements. Many patients simply cannot afford to pay these fees.
How can the mental healthcare crisis be curbed?
- Insurance companies should cover mental health diagnoses the same as any other medical ones.
- More psychiatrists and other mental health professionals need to be trained to fill the gap.
- Reimbursements to psychiatrists needs to be increased so more will rejoin the third-party system and patients can be covered under their medical plans.
- We need to educate the public regarding the nature of mental health disorders and destroy the existing stigmas.
- More inpatient and outpatient facilities should be formed.
It is difficult enough to be afflicted with a troubling and even dangerous disease. But, add to that the fact that people will stigmatize you for having that disease and think you can rid yourself of it just by thinking it away. On top of that, make it difficult to receive medical care and you created a true crisis. Isn’t it time we allow these patients the same medical care that other patients are granted?
Copyright secured by Digiprove © 2016 Linda Girgis, MD, FAAFP
In Florida, there is a large network of mental health counselors and marriage and family counselors that can help patients with mental illness just as well as MD’s or PhD’s. Perhaps if your local therapists are too busy these other health care providers will be happy to see these patients.
In NJ, it is hard to find these healthcare providers as well.Thanks!
Great article but drop the headclutcher photo. Photos like this increase implicit bias and diminish your message.
You are right. I just changed it. Thanks!
“…This is simply unacceptable. No one would tell a patient with chest pain they need to wait 6 months to see the cardiologist…”
And yet we (MDs, Insurers, government health departments etc.) do it because we have allowed Medicine to be dehumanized.
Medicine has become a business.
If we can’t and won’t address the issue inside our hospitals, medical colleges, and med schools, how will we solve the public crisis?
To rectify this we have to start with medical colleges, who stigmatize mental health issues–even under MDs. So why will MDs think different? On their annual licence renewal questionnaire, they group mental health Qs together with Qs about criminal activities.
This has to change.
Medical school training –we are training technicians, (students & residents), brilliant ones for that matter. And yet, mental health issues–are deemed “different,” and for the most part ignored, or when acknowledging it, applying regulations and assistance in a punitive fashion.
The stigma is taught from the 1st year of med school.
We can change that.
Are insurers interested?
Why do they pay psychiatrists so poorly?
It can only change if we stop paying lip service, claiming we adhere to the “Quadrupple Aim,” when we don’t. (Tripple aim plus taking care of the caregiver.)
Somebody needs to be courageous enough to stand up.
We need many somebodies.
Brave people.
We can.
Will we?
Thanks for shedding light on the crisis and reality, Linda!
Thanks for your comment and I agree! I think stigmas start right from the beginning of medical education. Doctors are not immune from stigmatizing and perhaps we should be the first to end it.