Critical Questions on Mental Health in America

The topic of America’s mental health system and the need to improve it has become a hot topics following the most recent gun violence at an elementary school in Connecticut. Most of what I have heard from the media and politicians is a broad “need to improve mental health.” It is always a very generalized statement without many specifics on how or where or to what end. It is likely that these pundits and politicians have no idea, but I think this leaves a critical gap in the mental health discussion.

“As soon as I’m finished speaking here, I will sit at that desk and I will sign a directive giving law enforcement, schools, mental health professionals and the public health community some of the tools they need to help reduce gun violence.

We will make it easier to keep guns out of the hands of criminals by strengthening the background check system.  We will help schools hire more resource officers if they want them and develop emergency preparedness plans.  We will make sure mental health professionals know their options for reporting threats of violence — even as we acknowledge that someone with a mental illness is far more likely to be a victim of violent crime than the perpetrator.” – President Obama 01/16/13

An article that I read noted that it was easier to buy a gun than to access mental health services in America. Why is that true?

Mental Health Services Stigma

I seems as though the mental health climate in America is very similar to the stigma associated with PTSD within military circles. With the conflicts in Afghanistan and Iraq I remember reading that soldiers wouldn’t seek out counseling  for their PTSD because it was interpreted as if the soldier was unfit for service and had serious issues. This applies in both the military and civilian settings. When a soldier leaves duty they may still face stigma related to their PTSD.

Likewise, this often plays out in the civilian world. Seeking counseling is never seen as a positive endeavor. Meeting with a psychologist is a negative event in your life that you never hope to repeat and you most definitely don’t tell anyone publicly. But why?

Why Seek Mental Health Services?

What causes people to seek out mental health services? Are individuals only referred by their family doctor or sometimes do they attend because they are required?

Many people seek out mental health services as a result of substance abuse. Dealing with addictions is probably the most well recognized aspect of mental health in the US. However, there is often a high degree of stigma even for those with mental illness and addictions. Overcoming the stigma and discrimination against those in need of mental health is a huge hurdle if President Obama and others hope that mental health will be more easily accessible among the general public.

Other well known reasons for mental health services are: depression, bipolar, anxiety, and PTSD. Nearly 80% of individuals who suffer from depression say that they experienced some form of discrimination (Mental Health America). Other studies have found that racial discrimination and an individual’s level of poverty also contribute strongly to mental health. However, a recent poll has found that stigma against depression and seeking treatment for depression is decreasing.

Where are Mental Health Services Accessed?

I know for many students being on a campus makes it fairly easy to meet with a Counselor at various locations. How would individuals without easy access find and utilize mental health services. I know that individuals can go to a hospital or an emergency room if they are in immediate need of mental health services, but that can’t be the ideal method of accessing mental health.

Most people probably have no idea that they have access to preventative mental health care with their insurance, however this goes back to the stigma associated with seeking such treatment. The other major barrier to accessing mental health services is the high cost with a minimum around $100 and extensive treatment reaching over $10,000. As a result of the cost barrier, only around 7% of all adult Americans accessed mental health services (NSDUH report).

Since the majority of mental health tends to affect poor individuals this cost barrier makes it even harder to identify and treat mental health. Mental health services is included in the “essential health benefits” piece of the Affordable Care Act, but it is left up to States as to what is included. Without some serious thinking about why, how, and where individuals access mental health services – improving access will just be more political rhetoric. If we are serious about improving the mental health system then we need to be asking serious questions.

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