One in four Americans is affected by mental illness every year, yet only a small percentage receive treatment, according to the National Institute of Mental Health.
Both individuals and our society share the pain that results from untreated mental illness. Untreated mental illness is related to substance use, suicide, homelessness, preventable disability and unemployment. It costs the United States $100 billion per year.
Effective treatments exist. But barriers such as availability, accessibility and acceptability impede the ability of individuals to obtain services.
The lack of availability stems from the shortage of mental-health care providers and the unequal distribution of those providers. Psychiatrists are in short supply across the country, especially in rural settings. In response, many individuals seek mental-heath services from their primary-care providers. Primary care providers are excellent resources but they do not always have the time, education or skills to provide comprehensive mental-health services.
Access to care not only means the ability to travel to seek mental-health services but also includes having the means to pay for those services. Obtaining care in rural areas may require traveling several hours for a single visit. This may take time away from work, and traveling long distances can be costly. An estimated 20 to 25 percent of Americans have no form of health insurance. They pay for health care out of their own pockets. Even with health insurance, individuals may have to meet co-pays and deductibles. When the choice becomes paying for food, rent or heat versus counseling or a psychiatric visit, the basic needs win out every time.
The acceptability of seeking mental health treatment can also be an issue. For many individuals, seeing a mental-health provider carries a tremendous stigma. The stigma may be related to a fear of reaching out for help if the person has always been self-reliant.
Many individuals lack an understanding about the causes of mental-health issues and the treatment options. Because of the stigma of seeking treatment from a mental-health provider or a “shrink,” an individual may delay seeking much needed care.
Integration of behavioral health into primary care is one approach to providing more available, accessible and acceptable health care to all patients. Behavioral-health providers, such as counselors, social workers, and psychologists, not only treat mental health issues but also help primary care providers manage chronic disease. Integration of behavioral health brings treatment to the patient rather than creating barriers to health care. Behavioral-health integration also reduces stigma, since services are provided at a medical, rather than mental health, facility. In addition, the approach to health is comprehensive and involves the patient, behavioral-health provider, and primary-care provider collaborating as a team.
The World Health Organization notes “Health is a state of complete physical mental and social well-being and not merely the absence of diseases or infirmity.” But the current health care system distinctly divides physical and mental health.
Mental health is health and the American system of health care can no longer continue to separate the head from the body.
Camille Laudicina is director of Behavioral Sciences with the Montana Family Medicine Residency at RiverStone Health. She can be reached at 406-247-3369 or firstname.lastname@example.org