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.