Where I practice, the process of referring a patient suffering a mental illness is quite infuriating. The wait to get in to see a psychiatrist or psychologist can be months all the while patients are suffering. Worse yet, with certain insurances, there are just no mental health providers available for any of their covered patients. The failure of treating mental health disease in the US is glaring.

In the US, approximately 1 in 25 people suffers a mental illness in any given year that limits one or more life activities. Despite the fact that mental illness is so prevalent, service to treat these disorders is not. Many psychiatrists now operate a cash based practice because they were losing money treating patients. And many patients just cannot afford treatment out-of-pocket.

As a primary care doctor, I treat a host of various mental health issues including anxiety, depression, bipolar disorder and more. However, there may come a point in treatment that I am outside my comfort zone and a referral to a specialist is the most appropriate course of treatment. When this is not available, there is little that can be done for the patient. I can continue to practice outside of my area of expertise but this is not truly a good idea for the patient or myself. The patient may end up in the ER if a worsening of the disease ensues. Here again, this is not the best course of action. The patient may simply give up in this flawed system and hide their disorder.

Many stigmas exist around mental illness and this deficiency in the medical system perpetuates this. Mental health issues, thus, appear to be deemed less important than physical illnesses. If they were equal, the coverage should be the same. However, benefits for mental health care are covered differently than other diseases. Different customer service lines are in place making it even harder for a patient to admit that they may be experiencing a mental health problem.

While many in the general population stigmatize mental health disorders, the medical community should not. A patient with a mental illness should be able to seek and obtain medical care as easily as a patient with a physical disorder. Mental illness can lead to dire consequences, just like physical disease. Additionally, mental illness may have a confounding negative interaction on physical illnesses. For example, in patients who suffered a heart attack, those who also suffer depression tend to demonstrate a higher mortality rate and their 1-year survival rate is worse than those without depression.

How does the system fail those suffering mental health illnesses?

  • Services are more difficult to secure. Access is a true problem and many with mental illness go without treatment simply because they cannot obtain an appointment to see a specialist.
  • Patients with mental illness are differentiated from those with physical disorders from the moment they receive their health insurance cards. Look at your card and you will see a phone number to call for mental health coverage. Both should be treated equally.
  • Physical illnesses are seen as more urgent. While anxiety or a panic attack do not tend to be life-threatening, they can be disabling for those suffering from them. Prompt care should be just as available to them as if they had an urgent physical condition.
  • Many mental health services are not covered forcing patients to choose whether to pay for care themselves or go without.

In our current times, research provides a sea of knowledge of mental health disease. However, if patients cannot benefit from this knowledge it is really rather useless. Until we equalize mental and physical disease, stigmas remain and we enhance the patient suffering.

© 2017, Linda Girgis MD. All rights reserved.

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8 thoughts on “The Failure of Treating Mental Health Illness

  1. I really appreciated Dr. Linda’s thoughtful reply and sent in an additional comment that was awaiting review. Was it edited out? The only reason I ask is because I believe that there must have been more replies from other physicians and I wanted to see how they responded to Dr. Linda’s thoughtful post. I’m sure more than three replies were sent in! 🙂

    1. Hi there! No, it was not edited out. I approve all the comments myself and am just behind. I truly appreciate your kind words and do hope it is helpful for other doctors.
      Dr. Linda

  2. As always, Dr. Linda’s are very well written and she raises the awareness of how the world of medicine is evolving…….or not evolving in the case of mental health care. As a practicing psychiatrist in private practice, however, I’d like to point out that the waiting list for a new patient to be seen in my practice is at least two weeks. This is not because of payment issues or because I refuse to only take certain types of cases. It is because my practice is “busting at the seams” with very severe cases that require my care and time. I don’t believe in fifteen minute “medication therapy” so all of my patients are given the opportunity to see me for at least thirty minutes or fifty minutes. I agree that a heavy burden has been placed on family practitioners, internists, pediatricians and primary care physicians to treat patients for mental health issues until the patient is so sick that they end up in the ER or are forced into a situation where they only receive care if they end up being hospitalized on an inpatient psychiatric unit. When I get a request to take on a new patient and I am not able to see them within a week, I find that it has been helpful to our community when I make referrals to psychologists and social workers to see the patient until I can see them or one of my colleagues can evaluate the patient. Some of my patients come to see me and choose to pay cash because they do not want their insurance company to know that they are seeing a psychiatrist (which is NOT how mental health care should be viewed)! I have been able to educate and treat many of these patients to “convert” to having their care covered by their insurance plan. The problem is that as Dr. Linda pointed out, not all insurance companies provide the same coverage that the patient has for “medical” coverage, and therefore, they end up with a limited number of sessions to be seen by a mental health provider. I always try to push through with prior authorizations and try to make the case that the patient NEEDS to see me or THEY WILL end up either hurting themselves or others AND end up with an exacerbation of any medical conditions that they may have. I also refuse to be a concierge physician and I also don’t make patients continue to see me if they are better and are managing their illness quite well. I have an open door policy for established patients so that they know that they can always come back to see me if their condition starts to worsen. This is why my practice is busting at the seams! I’m doing my best to do what is best for my patients. Unfortunately, not everyone agrees with my approach but I need to be able to sleep at night with the decisions I make. I hope that there will be other physicians who find these comments helpful and consider creative ways to get their patients seen by a mental health provider as soon as possible.

    1. Thank you so much for your comments and you make many valid points that I missed in the original post. Yes, psychiatrists are in short supply and that perhaps is the biggest reason for access problems. Thank you for clarifying the payment model as well. I know only what my patients come back and tell me. Unfortunately, many insurance companies don’t cover psychologists or social workers so even this step while waiting for am appointment is not always available. My practice is 30% Medicaid and I believe they are the worst payers in most areas so I admit my experience may not be typical of most practices. I am especially heartbroken about the lack of child psychiatrists. So many kids are struggling these days. Thank you for all you do and it sounds like your patients are very fortunate to have you!

      1. You are always an inspiration for those of us that are in the field of medicine and I think that your patients are fortunate to have you as their physician! I agree that Medicaid is the worst in making it possible for patients to get the care they need or to pay physicians for the services they provide. Medicare is also getting to the point where geriatric patients are getting no care unless it’s a catastrophic event! We have a broken system but I try to remain optimistic in that I believe that if we can appropriately treat or save one patient at a time, we are doing the best we can under the circumstances. I am trying to see if I can get involved with lobbyists and attorneys who are challenging the current health care system so that patients can get the care that they need. It’s a very intense and grueling process to try to get our legislators to support our cause! Thank you for bringing awareness to the fact that mental health care continues to be stigmatized in our society and we need to continue to speak up about how it isn’t “different” from other medical diseases. The two are tightly intertwined and patients should be able to get as much care as if they had cancer or diabetes or any other “medical” condition. After all, we were taught in medical school that psychiatric conditions are medical conditions that require thorough evaluation and that medical treatments are available to relieve the suffering of our patients.

  3. This is a big problem. I’ve known several people with severe mental illness that just can’t get the help they need. It costs people their jobs, families and sometimes their lives. Investing in the mental health and well being is such a high return on investment, yet there is never enough resources.

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