Mental health issues affect everyone—whether in their family, their classroom, or on their streets. In any given classroom, there will be at least 2 children with ADHD, which affects the teacher and classmates. In offices, workers struggle with anxiety and depression—even Jon Hamm has talked about his struggle with depression. On the streets, unfortunately, the people we see railing at the sky are often schizophrenic.
Nationally, unless you are very rich, it is difficult, if not impossible to access quality mental health care in a timely manner. Patients commonly tell me they have called 8 other psychiatrists (who are full) on their insurance panel before calling me. Public clinics are often overloaded and understaffed. This is because our culture marginalizes the mentally ill.
There is nothing sexy about mental illness. There are no fancy machines or quick fixes. We don’t have easily-identified ways to support depression, bipolar, or schizophrenia. There are no analogies to the “wear a red dress for heart disease” or “put on a pink ribbon for breast cancer” campaigns. The stigma associated with the illness has carried over into funding. The primary sufferers, by virtue of their disease, cannot often advocate for themselves. Their family members often have their hands full caring for them.
State hospitals have had their problems. However, they were never fully replaced by the community-based wraparound services. As a result, there are many very ill people without care. Similarly, people with episodic illnesses are also without care. These can destroy lives, too. A major depressive episode can lead to job loss and can disrupt attachment between parents and children. Untreated depression after stroke leads to higher mortality, and bipolar illness can place families in terrible debt.
We know how to treat these illnesses, with evidence-based medicine. It involves a team approach, including social workers, therapists, and psychiatric consultation. The current method of sidelining or carving out mental health care further stigmatizes it and makes it harder to access both for publicly- and privately-insured patients. We have a moral duty to help our patients obtain care. Revamping the delivery of mental health services is not a new concept.
Increasing the capacity of primary care clinics to do aggressive case finding and appropriate management by properly trained providers, with easy referral when necessary, will improve both physical and mental health (i.e. holistic) outcomes.
Developing a medical home model may become one of the new delivery systems of health care in the United States. If psychologists and social workers are incorporated into its fabric, with supervising psychiatrists, we would improve the capacity to provide excellent care.
Since there are not enough psychiatrists, and far fewer than enough child psychiatrists, it is critical that their specialized knowledge not be locked away in individual practices but be shared among colleagues, whether MD’s or therapists. For complicated patients, the more highly-trained, the better, but this is not a time when we get to choose the “gold standard.”
There are never enough resources for mental health, and it is not a politically viable issue. However, I do not want us to advocate for substandard care. We must realize that physicians are the ones who have a science background, and know medication interactions, and, ultimately have the sense of “sick” and “not sick” developed through medical school and residency. Providing a forum and an incentive for psychiatrists to consult with the 80% of primary care doctors who prescribe the psychopharmacological medications to Americans would likely be a good start.
Cutting mental health care resources increases the pressure on emergency rooms and public services, which drives costs up for everyone.
Ultimately, access to affordable and quality mental health care is one critical reason why universal access to health care should be a right: fostering healthy individuals helps to make for a healthy community and, in turn, a healthy country.