Mental Health Services in the United States
Table of Contents Factors Influencing the Accessibility of Mental Health Services Geographic and Physical Barricades Limited Resources Social Stigma and Ignorance Lack of or Limited Insurance Coverage Solutions Conclusion References Mental health is considered a major determinant of a person’s well-being, interaction in the society, and family relationships. It is estimated that almost 40% to 50% of the US population develops a mental condition during their lifetime. The majority of these disorders begin in childhood or teenage years, escalating the risks for poor physical and psychological health, social relationship issues, and financial difficulties. If treated early, people with behavioral and mental disorders can recover quickly. On the other hand, when the treatment is delayed, the escalated mental health problems cost more in terms of finances and a person’s well-being. Therefore, it is paramount for individuals with these health issues to seek mental health services as soon as possible. However, according to Henderson, Evans-Lacko, and Thornicroft (2013), most Americans with mental disorders seek services after suffering from the conditions for a long time. This paper describes limited access to mental health services as one of the US health system’s major issues. Factors Influencing the Accessibility of Mental Health Services Most people suffering from mental disorders in the US are never treated at all, and the majority of those who seek treatment receive poor services. 60% of Americans residing in rural areas have inadequate mental health services (Murphey, Vaughn, & Barry, 2013). Several factors contribute to the limited access to mental health services, especially in rural areas. First, the relevant professionals are very few in the localities. Besides, most of the residents of such areas are not aware of all the available options for accessing behavioral health services, particularly mental health care insurance coverage; therefore, constrained resources limit them from seeking the services. Additionally, Americans who live in rural areas encounter geographic and physical barriers to mental health care services. Harsh stigma and lack of familiarity with the symptoms of behavioral health problems and the available treatment options, also contribute to inadequate access to mental health services.
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Geographic and Physical Barricades People who need longer mental care in the countryside may find it challenging to obtain the service due to obstructions such as remoteness and traveling time. The absence of transportation services is the major factor that complicates such barriers. The majority of people living in rural areas of America rely on Medicare cover only to cater to their health needs. Unfortunately, the Medicare program does not offer coverage for the transportation of patients who are not in emergency treatment needs. Besides, Medicaid only funds the emergency transport services for patients who live in areas with infrastructural problems, such as rural regions (Clement et al., 2015). Several medical organizations engage mental health professionals to offer their services in hospitals or homes of people with mental disorders to address geographical and physical hindrances to access to treatment. However, providers of mental health, as well as independent practitioners, are at times unwilling to offer off-site services, possibly because such activities are inconvenient, lead to lost opportunities to participate in billable work, and due to the unreimbursed travel expenses incurred (Lasalvia et al., 2013). The mental health care system in the US offers its services through related school-based programs to make the treatment physically available to adolescents in the learning institutions. Nevertheless, the budgetary allocations for school-based mental health programs have been substantially reduced since the economic downturn, which has affected the availability of such modes of health service delivery (Murphey et al., 2013). Perhaps the schools can offer mental health services. Still, they may not have adequate resources and personnel required to deliver comprehensive care for the children and adolescents suffering from severe emotional disturbance. Such patients may need medication and intensive psychotherapy services, which the school-based programs may not be in a position to offer. Limited Resources The Health Resources and Services Administration classified at least four out of five counties in the US as areas with full or partial shortages of mental health professionals (Lasalvia et al., 2013). Most of these regions are in rural settings. The inadequacy of mental health clinicians in the areas prevents people who need long-term care from receiving the right treatment for their mental health. To address the shortage, rural primary care providers act as immediate sources of mental health treatment in the areas experiencing inadequacy of psychiatrists. Unfortunately, there is an insufficient supply of care providers in general, and it is expected that their number is going to decrease further with time (Andrade et al., 2014). It is particularly difficult for rural communities without both mental health experts and primary care providers to develop service models that are integrated and multidisciplinary, thus the inability to address chronic physical and mental disorders in their population. According to Murphey et al. (2013), the US has an insufficient number of child psychiatrists and psychologists and pediatric behavioral specialists. In the pursuit of addressing the shortage issue, the scope of work of primary care pediatricians has been extended, making treatment of children and adolescents with behavioral disorders a responsibility of a primary care pediatrician. However, there is inefficiency in mental health service delivery by such professionals, which is, at times, worsened by the lack of motivation of the personnel. According to Corrigan, Druss, and Perlick (2014), Community Mental Health Centers (CMHCs) are the only systems that provide specialty mental health care in most rural areas. Therefore, the ability of CMHCs to provide the services is usually a major determinant of access to mental health by people who live in rural areas. However, the financial challenges faced by rural CMHCs limit the ability of the institutions to offer mental health services to the people who depend on them for their mental well-being, especially long-term care services. These financial problems are attributed to reduced state funding of mental health services since 2008. Between 2009 and 2012, states in America scrapped off general funds worth more than $1.6 billion from their budgets related to health agencies. The reductions in the budgets have led to a decline in health services for children and adults suffering from chronic mental illnesses (Lasalvia et al., 2013). The budget decrease has also resulted in the shutdown of community mental health programs, particularly in areas whose states have persistently reduced their budgets since 2009. Social Stigma and Ignorance Even states where mental health care is readily available and affordable, a significant number of the residents having mental issues do not seek assistance or reduce their contact with the services to avoid being referred to as mentally ill (Parcesepe & Cabassa, 2013). There is a social stigma towards people with mental illnesses, and that is the reason why the victims of the disorders do everything they can to conceal their mental health status (Yang et al., 2014). The majority of the American population, especially African-Americans, has little information regarding mental health services in their communities. Most of the people who have mental health problems only come to know about the available services of treatment for their health issues when the conditions have become serious. According to Henderson et al. (2013), parents, school administration, and medical providers are not keen on identifying early signs of mental health disorders, limiting timely access to the necessary care. Furthermore, many adolescents do not seek mental illness treatment since they and their parents do not see a need/benefit of the services or are worried about other people’s perceptions of them if they discover that they are seeking the services.
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Lack of or Limited Insurance Coverage Lack of health insurance or limitations by insurers on coverage for specific services limits accesses to mental health services. Many adolescents in the US do not have either public or private health insurance. According to Cummings Wen, & Druss (2013), adolescents who are not covered by health insurance policies have lower chances of accessing mental health services than those who have the coverage. This is partially the reason why the majority of adolescents in rural areas who have mental illnesses do not access the necessary care since most of them do not have mental health insurance covers. However, with the implementation of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, more children in the US are expected to have mental health insurance covers. Solutions The awareness of the identification of symptoms of mental disorders, the importance of seeking, and the availability of necessary health services should be promoted amongst the US population, especially in rural areas, to improve mental health care accessibility. School-based programs, community programs, and health providers should be empowered to help them offer screening services for certain mental disorders and promote mental health. Mental health codes’ consistency and universal parity amongst third party payers, such as insurance companies, will also address the limited access to mental care by people in the US (Lasalvia et al., 2013). One way of addressing geographical barriers to the accessibility of the services by low-income patients is to expand the capacity of safety net facilities offering primary care services, for instance, rural health clinics, to enable them to offer mental health services to the young population. Besides, the number of mental health clinicians, particularly those specializing in offering services to young people, should be increased in the United States, especially in rural areas (Thornicroft et al., 2016). Educational outreach efforts regarding the problems and available treatment options are important tools for addressing knowledge, attitudes, beliefs, and the stigma associated with mental health issues and treatment. School health curricula ought to be expanded to address mental health issues and treatment options better. Conclusion Mental health is vital to every person residing in the US, and it is paramount to accord it the attention and resources it deserves. Adequate accessibility of mental health services will be achieved due to collaborative efforts by the community and the governments of the states. As society strives to change its perception towards mental illnesses, the government should ensure that all its citizens can easily access the appropriate services that they need for effective treatment options. References Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., & Florescu, S. (2014). Barriers to mental health treatment: Results from the WHO world mental health surveys. Psychological Medicine, 44(6), 1303-1317. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11-27. Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70.
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Yang, L. H., Purdie-Vaughns, V., Kotabe, H., Link, B. G., Saw, A., Wong, G., & Phelan, J. C. (2013). Culture, threat, and mental illness stigma: Identifying culture-specific threat among Chinese-American groups. Social Science & Medicine, 88, 56-67. Cummings, J. R., Wen, H., & Druss, B. G. (2013). Improving access to mental health services for youth in the United States. JAMA, 309(6), 553-554. Henderson, C., Evans-Lacko, S., & Thornicroft, G. (2013). Mental illness stigma, help seeking, and public health programs. American journal of public health, 103(5), 777-780. Lasalvia, A., Zoppei, S., Van Bortel, T., Bonetto, C., Cristofalo, D., Wahlbeck, K., & Germanavicius, A. (2013). Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: A cross-sectional survey. The Lancet, 381(9860), 55-62. Murphey, D., Vaughn, B., & Barry, M. (2013). Access to mental health care. Child Trends: Adolescent Health Highlight, 2, 1-2. Parcesepe, A. M., & Cabassa, L. J. (2013). Public stigma of mental illness in the United States: A systematic literature review. Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 384-399. Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123-1132.
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