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.
Copyright secured by Digiprove © 2017 Linda Girgis, MD, FAAFP
mental health lies and myth stigma. I got sick as a kid. diagnose and cured it three years later bulimia in art school. I went to art school to get out of toxic family that included a mentlaly ill food addicted father who was a MD, and abuse me for being sick. I had sense he did not. he also could not cope with a sisters illness and delusional for a dr he had serious ignorant notions and did not know or care to do what I did. look up it in medical books . his own. I got to school went to hell to get to heaven and did come up over it. I was a very healthy kid and I came home to abuse and insult and then told I had to work. after I did and happy and to go back to school he or wanted a dr to diagnose me with something to keep me home. my brother droped out of school sister and rewarded them. I spent 11 year of cptsd induce abuse and traumatize me to have me electrocuted in insane hysteria lies he crated out of some delusion and want of keep me out of school or grow. I ended up to run into nyc and lived a harsh life. so harsh and between a sick family I turn feral, isolated and a victim of a very serious abuse and game. someones intent and finding a kid instreet who was not cared about making me ap erfect victim of torture. my family wanted me to be sick. someone was rising it and I was left to suffer. in a story of brilliant and defiant. I took a leap of faith from daily terror and abuse lack of love and isolated nd speachles and cures follow by somene in a kidnapping mind game thing and family lies. I was abused on all sides. and then I got to live my life got this job walk out of hell and it wanted to follow me buti got back to art world I was taken from art school. I began what became 24 years of recovery of this alone. no dr and my bulimia I had to keep moving up from and maintain that and I did a few thousand hundred miles of work to recover and gu up. instead of support and concern and help I was abused and wing monkey and red herring to keep my mouth shut of someones part of this. possible an insane sister who is all bout saving her fake ass. I knew I as going to be a target of murder as I rise up to my place as I kid and health and followed. as I cut my family off she tried to come after me when I became happy again and cut them off, for keep me down and cold treat and denial that I had to consume hate and love. or cold as love. if I did id lost the game then. so this is what they did to turn tables on me. the sister came after me when I moved, I was now healing in jobs and Jamaica and rising back . I feel this was a sociopath move because I was a source and they were keep me down for competition. I still had a means to heal and I lived a terrible life and then began to heal. people used me as scapegoat even in my job I loved and art world but I was the one with gods blessing still and no issues of them. so I as jelousy target and abuse at same time . I did not stop by people and god mind me. 24 years of seeing persons sent to abuse me failed and I grew into a correct survivor not an abuser to go out and do to others what was done to me. I walked away from sick and got the it life . so I knew I was go see some trouble and escape sick people sent to damge me. testing me almost to brink of madness and I healed from a lot of things of ptsd and feral which is a blessing. I was oritaneted to medical and other common sense wise. and survivor. some of the persons sent to kil me an failed did not go awa fully and one of them in past five years a enabled psychopath and out f control mental case, as all of them were, had a intent to get even even after he got a woman and got his wishes. he wanted to kill me and beat me it was not out of anything but jelousy and evil and he is a lose cannon thinks hes cute. noting worse than someone who thinks hes cute and the it guy a loser. living off others money. I was gifted worked to regain talents and hard very yhard to repair my brain. to see this person and others in my life was sad. I had god and god did bless me. and as I got up and older and gain and rise idid not fall down I wasn’t old and did not fail. so they came to a pack to induce fatal blow to me just as I was go reach the place other cant and I was the wise person and know my game . I folded and escape some sick person and this one and the master of my abuse who I got rid of I feel might have ties to family, jealousy or some dark person, had a plot and could not fool me. a man was set up after the one I left and know this man was go be used to kill me and how. so I walked around it. I was about to leave after a month of travel and then the person I walked around who might been frustrate also substance and denial and ego and other. moved in me . but the issuw as before he moved on to me. I had experience a shot at me to unstablize me and alter my copin skills were damage or tamper with and my brain had esxperince in company of this kind of presons to do this to me to alter me so they could sexual assualt me using a tactic that throws off the victim mentaly and paryulize them to unable to move and act in some hypnosis manner. leaving me in shock and fixing it and thank god I was not done or dead . in middle of fix this the man was to act on on me which drove me into over load shock and to see a person that culd really damge me in that state put into the game and instantly it was a bomb and trap and I began to die. I went from with god and happy fixing me and then see death and my life deleted to like a state of no spirit no person and before birth of somene violent did this to me and he was used as trigger . I began to try to go into a recovery mode and saw that there was no recovery of my brain and I began to try and was then left for weeks being toss around call in toss out and humilated while my identity was being damage and destroyed and die in front of this man, who would cast judgment on me and see me as this and destroy me induce mental problems and schizophrenia as a plot and depression and brain damage and the loss of years of artistic work and journey and fixing of a master work of a effort to not lose to 11 years of torture. I was an expert and master in one second someone an antichrist of my abusers set this up and alter me so that this man, would lead to horror and for him to reject me to mimick a thing I experience all of some experience in life and then lead to death. I held on got to dr am onth later in nyc and she sat there like it was tea and then left me to die. persons flock to wounds as soon as the man toss me off to abuse me and tear me up, I was left in street and then more and more damage and exhaustion and in last four years I was reversed and sent to hell and my life which was blessed and miracle fed to dawgs and persons began to tear me up and ransack my mind for the money of me my worth and I made 911 calls to persons who sat like wickerman and indulge in it. made me the bad kid the problem. the problem where had no drug issues no mid life crisis no age issues and a talent , until this man with all of issues st down and did work for the punk who abuse me. it was part of a game. and I am now set to die of things and because I was left so long , and kept feral and fall down and go insane and hold on, they all began to tear me up and I lost m life and left to lowest life of all. my family sat there and did not have much to say like lets get donuts or go for pizza and so what. so what you suffered 11 year. it was not them.
it was me. they had normal life. I got o outwit them and the older sister did not like being the one on bottom of my rise up as famous, and began to emulate or go places or do things I was doing and call her self by names of like Jackson pollock soul mate. despite she offers to help me as I’m hit and drag int them so they can over power me, she sat there like scar in lion king. leaving me to suffer and die and not one person flt for me or remove me . how sad. I’m a mental loss and can not ever be person. instead of survive feral abuse this time it took moths to t urn me feral and this time for good and the kind where I can not thrive in real world survive or make money and its all about know im out of way and toured me with this man. there are corrupt dirty shallow people but no one like me to spare me. how sad. there is also criminal elements and my fear to but wanted to and tried to contact fbi about my abuse..
how sad. how disgusting on part of society to allow some rapist punk to take down a hero and indulge in themselves. how sad no one who as a kid toss me to sex addicts and failed to damage me to did not care to save my life. it was ok to use and abuse me but not save my life and try to pit me next to a cousin who called me when she ran inot one of my famous ex bf at a party while I was suffering and would go for the guy they used to abuse me . substance abuse personality and trash. iw as a very uncorrupted person and I took the beating for society and abuse . I was not mentally ill and for this they found a way to induce it allow me and by removing coping skills. I almost out wit this to if a dr had remove me instead I was kept in place that would kil a strong person in stress and trauma and lack of rest and infested with parasites. is there anyone I can tell I’m speechless feral mute, and brain damage. alone. About my whole life.? my social worker now process ing me to homeless instead of stop it. I was made into a hopeless case from ast ar driving me instantly to insane . this is cruel and unusual and they feel its a joke my abuser is getting of laughing thinks his r Kelley and a joke. leading to my death is a joke. makes up his own reality like the sister.
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! ?
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
Aloha!???
Aloha to you!
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.
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!
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.
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.