Last week was Mental Health Awareness Week. It was the 33 October in a row in which advocates across the United States worked together to sponsor week-long activities large and small to educate the public about mental illness.
Certainly, raising awareness of the issues surrounding mental health issues should be the start of a process to address them. Yet society is not doing enough to fund mental health research, provide adequate resources to alleviate inpatient bed shortages, adequately pay health care providers, build infrastructure, and cover the medical costs of patients. Awareness is a necessary, but not sufficient, condition for tackling the societal problem of mental illness. It is imperative that mental health care receives adequate funding and support.
More than a fifth of American adults suffered from mental illness in 2020 (nearly 53 million people). And, 5.6% of American adults had a serious mental illness in 2020 (more than 14 million people).
In 2021, 47,646 people in the United States died by suicide, compared to 45,979 in 2020. Experts had hoped that suicide rates would have peaked in 2018, after rising steadily between 2000 and 2018. The numbers fell slightly in 2019 and 2020. But the 4 percent increase in 2021 suggests the two-year decline was a temporary blow.
Psychiatric hospitalization is the treatment option of last resort for people with severe acute or chronic mental illness who require intensive care in a hospital setting. However, the beds are missing.
The number of psychiatric beds per 100,000 population in the United States ranks 29th among the 38 countries in the Organization for Economic Co-operation and Development.
Recently, the shortage of beds and resources for psychiatric patients has accelerated, leading to severe bottlenecks in hospitals and very long wait times for admissions. A psychiatrist working at Massachusetts General Hospital said that over the past week “we had up to 39 patients in the emergency department seeking psychiatric services, and on Monday we had 11 people who had been there since at less than 100 hours”.
This is unacceptable. Equally inexcusable is the fact that in Massachusetts in 2020 and 2021, more than 350 beds in psychiatric facilities were cut due to staffing shortages in the state’s behavioral health system.
The system is dysfunctional from top to bottom. Reimbursement rates are much lower for caregivers involved in behavioral health. Additionally, there are not the resources for a proper physical base – proper facilities and building space – to accommodate increasing numbers of mental health patients. Additionally, historically, there has always been an uneven playing field between insurance coverage for patients with mental and physical health conditions.
Clearly, misconceptions about mental health persist. Nearly a quarter of Americans still do not consider mental health to be as important as physical health. Given this attitude, society seems willing to spend disproportionately more on somatic illnesses than on mental disorders, despite the heavy disease burden and high economic costs caused by mental illness. And so, there are gaps everywhere, from lack of funds for research – mental health does not receive as many public donations as somatic illnesses – to below average treatment coverage.
Lawmakers have attempted to fill in some of the gaps in coverage. For example, prescription drug coverage for mental health conditions has improved over the past decade, at least in some insurance markets. In Medicare, for example, antidepressants and antipsychotics are included in the six “protected drug classes”, which means that “all or almost all” drugs in these therapeutic classes must be covered by Medicare Part D (outpatient drugs). . ) plans. Additionally, the Affordable Care Act (ACA) provided one of the largest expansions of mental health care coverage to date when it was signed into law in 2013. Individual and small employer health insurance, including all of the plans offered by ACA exchanges, covers a fairly comprehensive assortment of mental health services.
However, much of the commercial insurance industry is not subject to regulatory safeguards that ensure more equitable mental health care coverage. Moreover, the legislative measures and regulations mentioned above often do not extend to the guaranteed coverage of psychotherapy; for example, cognitive behavioral therapy (CBT). In many cases, CBT is used in conjunction with drug therapy. Yet public and private sector insurers often only cover the latter, not the former (or only to a very limited extent).
Additionally, reimbursement rates for psychotherapies for health care providers have stagnated or declined for several decades, which is extraordinary given the growing mental health crisis during this time.
Although awareness of mental health and the significant burdens posed by mental illness is improving, society is not doing enough to address the problem. More action is needed.