Big Shoes Net Only Baby Steps in Campaign to Make Quality Mental Health Care Accessible to All Americans
“…[we must] tackle the difficult issue of mental health.”
President Donald Trump, in response to the recent Parkland, Florida school shooting
The 2018 promise of the Trump Administration, the 2010 landmark Affordable Care Act (Obama Care), the 2016 21st Century Cures Act (Cures Act), and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) combined to make a positive “dent” in the problem of making quality mental health care more accessible to more of those who suffer from mental or emotional disorders, but the accessibility to quality mental health care continues to be a major problem for millions and millions of struggling Americans.
In 2011, 19% of persons with mental health issues, were uninsured for mental health treatment. In 2017, 17% were uninsured for such. But, that 17% represents over 7.5 million United States citizens. That’s still way too many. In 2011, 59% of those with mental health issues did not receive treatment. In 2017, that number was down to 56.5%. Further, 20.3% of those who sought treatment in 2017, and were insured to cover it, still could not get it. That’s way too much.1
64.1% of youth with major depression in 2017 did not receive mental health treatment. That’s 3-in-5 who are most at-risk for struggling in school, for having difficulty in relationships, and for tending toward suicide. Sadly, 7.9% of those youth with mental or emotional problems and who did have insurance, were not covered for such health issues.1
“Having insurance coverage does not mean access to needed treatment.”
Mental Health America
Many mentally and emotionally ill Americans still lack insurance, many of those who are covered still lack adequate care for mental or emotional health issues, still far too few healthcare treatment providers exist to meet the growing demand, the mental health care industry still has a severe shortage of available treatment types (both inpatient and outpatient services), and the stigma that is unfortunately attached to seeking and or receiving mental or emotional health care very very real. And underpinning all the above obstructions to potential patient access to mental health treatment is the cost of quality therapy is just way too high. The typical cost of an hour of treatment can be as high as $250, but most often ranges from $75-150 a session. A year of such treatments, participating once a week could run approximately $13,000. Even the upper end of the average family cannot afford that.
“The cost of mental health care has always been a great barrier to accessing care for people with mental health care problems.”
U.S. National Library of Medicine and National Institutes of Health
Adding insult to injury, for youth with a mental-or-emotional disturbance in schools, only .771% are identified and qualified for services through an Individualized Learning Plan. Experts say that some 8% of the total school population is actually in need of such services.1
“Even the Affordable Care Act required insurers to provide coverage for behavioral and mental health care, [but] the cost of treatment often limits access to mental health services.”
Experts say 1 in 5 Americans experience a serious mental health issue in their life. In actual numbers, that’s 6,535,334 people (326,766,748 U.S. populations, 2018).2 My guess is that’s a pretty conservative estimate, considering that admitting you have any such affliction still carries quite a heavy stigma.
Professional estimates claim 1 in 25 Americans live out their lives with a serious mental illness, including schizophrenia, bipolar disorder, and major depression.2 These persons not only represent a serious risk to their health and safety but those around them as well. A case can be made that even though the cost of mental health therapy is exorbitant, the potential cost of not effectively treating these unfortunate souls, and not just in dollars, is much greater. The negative impact of that large of an untreated population will have a devastating impact on suicide rates, legal issues, family conflicts, employment status, substance abuse, shifting cultural morals, homelessness and our country’s overall physical health.
“The mentally ill have nowhere to go and find little sympathy from those around them and often land in emergency rooms, county jails and city streets…[or even] in the city morgue.”
We very much need to take seriously, sooner than later, making sure the mentally ill get what they need…all of them. They need to be helped to live as safely and as normally as possible, so we can.
There are 5 basic obstacles to this need becoming a reality. And believe me, it’s not all that simple. Many have tried and failed.3
1. Financial Obstacles
The cost of mental health treatment is the single greatest limit to accessibility. Even with Obama’s Affordable Healthcare Act, copays and deductibles are still not affordable. To get the full Monty, intensive and long-term therapy, medications and follow-up are necessary. Something has to give. It can no longer be the millions of people who need treatment and either don’t get any or who have to settle for the slim pickings their healthcare plans can cover.3
2. Available Professionals
89.3 million Americans live in what are called “federally designated” mental health professional shortage areas. The is no steeper category amongst all health resources and service administrations in the U.S. These persons, no matter if they live in remote areas or rural countryside, or are socio-economically deprived, suffer on long wasting lists for precious few available mental health professions. And to make things worse, for those few professionals that “play along” with the current system must wait for long periods of time for promised reimbursement for services they do manage to provide.3
3. Education and Awareness
More than likely because they are not so readily obvious, many people still do not take seriously those who are mentally or emotionally disordered. You can see a dismembered limb and can respond accordingly. It’s a much different situation when someone suffers from social anxiety. Those persons are likely to be seen as lazy, or not motivated. It is critical that society is better informed about the realities of such a dark existence. It’s not just in their minds.
“People…fear that family and friends will avoid them or treat them negatively.”
4. Social Stigma
There is still a perception of shame that many still carry with them if they admit they have a mental or emotional problem, which prohibits them from seeing the treatment they so need. It is the fear response that comes from reacting to those around them whose awareness and understanding are greatly lacking. Hand in hand with improving the country’s awareness of the realities of mental illness needs to come helping those with possible problems to come out into the light to get help…without fear or shame.
5. Racial Barriers
“…white people are the only racial group in which a majority of people with severe psychological distress get treatment, reports Social Solutions, citing a finding in studies leading to the drafting of “Obama Care.” The reality is that half of all people facing severe mental illness, and who are most likely to receive no treatment, are black, Hispanic or Asian persons. Disenfranchisement in the arena of mental health access runs clearly along racial divides.
“Mental health problems [still] tend to be under-researched, undertreated, and over-stigmatized.”
June Gruber and Darby Saxbe, clinical psychologists
There is no time like now to do more than improve the U.S. Mental Healthcare Industry. June Gruber and Darby Saxbe, both clinical psychologists, writing for Slate, urge America to find any way to do 5 basic things.
1. Early Investment
If we want to get out ahead of the curve on mental illness in this country, we must make a concerted investment in both early identifications of the onset of mental and emotional disorders, but also the implementation of treatment that works, especially in a multi-dimensional format, providing wrap-around services for individual children and their families.3 Playing the game of catch-up has gotten us into the current deep hole we are in.
2. Treatment Over Punishment
Instead of knee-jerk incarceration of persons with mental illness when they run afoul of the law, place them in secure facilities that provide psychiatric care while serving time.3 All too often, we treat such persons as throwaways and simply lock them up to keep them from doing any further harm. Eventually, they will be released and try to live in the general population. With no other intervention than spending time behind bars, is it any surprise when the misbehaviors continue and they end up right back in jail?
3. Affordability and Accessibility
We know a lot more these days about how to help those with mental and emotional difficulties. Why don’t we make it more readily available? The demand is high, but the supply of professionals is short. And the few who are available to help, charge an arm and leg, thereby marginalizing more than 50% of the entire mental health population. We band-aid the problem with insurance packages that don’t really cover what needs to be done. We offer online services like it was the best thing since the invention of the mouse trap. Such services are a far cry from the real deal, but a lot less expensive. What about those who have disabilities and cannot access even the basic health services they so need? What about those living in remote areas, or who do not have to a means of reliable transportation? And what about language and cultural barriers, too?
Mental Health Parity Law points to supporting and funding mental health research. What would help most is if the largest funders of mental health research in the U.S. would concentrate their energies and their monies on research in areas that most directly help the afflicted. Start with NIMH, the National Institute of Mental Health, the largest of the nation’s research funding organizations. Take the lead. Set the tone.3
5. Combat Stigma
“Amercians by a 2-to-1 margin [still] blame mass shootings on problems identifying and treating people with mental health problems instead of [better] gun control.” concludes
Slate, in their 2018 article, featuring clinical psychologists June Gruber and Darby Saxbe. Inroads on better awareness and understanding have to become a much bigger priority in this country.
“Mental health treatments remain largely unaffordable to many, especially to those from low-socioeconomic or disadvantaged groups.”
June Gruber and Darby Saxbe
ThriveOn Steps Up to the Plate
ThriveOn wants to make mental health care affordable and accessible. ThriveOn is an IT startup that wants to provide care for their employees like never before. Realizing that 1-in-5 Americans experience severe psychological issues at one time or another (or others), and unlike most tech companies, it wants to take the mental and emotional health of its team seriously. They ultimately want to make it easier for people who are struggling through a difficult emotional time to get the help needed.
ThriveOn offers up to 3-months of individualized time with professional therapists that users can access on their smartphones.
“Part of our mission is rebranding mental health,” explains founder Alejandro Foung. “Even hospitals don’t want to deal with it and physicians don’t want to deal with it. Part of ThriveOn is to demystify and destigmatize mental health care.”
ThriveOn works closely with mental health researchers at Stanford University, Washington Universtiy in St. Louis, and Pennsylvania State University.
The cost of this effort by ThriveOn has yet to be determined, but it is expected to cost less than $100 per month per person.
ThriveOn’s therapists work through an “app” program, providing weekly interaction and feedback. Often the interactions or information sharing takes 5-15 minutes per person.
“That’s how technology can play a role by providing engagement…[thereby changing] the delivery of primary care…to provide great care in a new, more accessible, cheaper way.”
Affordability is also becoming more a reality of the present at ThriveOn. Hurdling the limitations of insurance providers, and wiping away the stigma attached to having a “mental moment,” means people who need help don’t have to reach out for it on their own. Providing it for them at an un-prohibitive rate that they absorb makes the whole process rather easy, almost inviting.
What ThriveOn offers is not a panacea. It is not for everyone. There is still the need to refer out persons who come to suffer a serious psychological disorder.
If a company like ThriveOn can see the importance of their employee’s basic mental and emotional health, both personally and professionally, everyone’s bottom lines benefit.
A Layman’s View
From my layman’s eyes (I am a professional educator and not a licensed therapist), I say that if we really want to get to the source of the infection that prevents access to mental health care in this country, which is affordability, we have to do like the grocery stores do. They make wholesale price cuts. They slash costs. They reduce rates. Why do we spend our wheels so much trying to protect rates for therapy that have no basis in reality? As an industry, cutting the cost per hour of services provided would almost immediately increase the number of buyers in the mental health market. Does counseling have to cost so much per hour? And with the aid of technology, the actual time that needs to be spent per session can be reduced and made more flexible and appropriate to the time at hand. Does it really have to be an hour per visit? These adjustments alone would allow therapists to be more strategic and prescriptive in their time with patients, and actually see more of them in a given day.
It’s not rocket science, but then again, I am just an educator, who has personally experienced the artificial structuring of time and place by counselors to do they work they need to do, and more than survive financially. Does it have to stay that way? Does it have to be the way it is because that’s the way it has always been?
1 “The State of Mental Health Care in America,” Mental Health America, 2017.
2 “Top Barriers to Mental Healthcare Access,” Social Solutions, 2017.
3 “Five Improvements We Should Make to Mental Health Care,” June Gruber and Darby Saxbe, 2018.
4 “Thrive On Wants to Make Mental Health Care Affordable and Accessible,” Tech Crunch, 2018.