The well-discussed physician shortage is affecting healthcare across the country and across specialties. But, when it comes to mental health professionals, the numbers look even worse. For context, the Health Resources and Services Administration states that 55.3 million Americans live in a federally designated primary care shortage area, while an astonishing 89.3 million live in a similarly designated mental health professional shortage area. Those numbers, worrisome enough on their own, are even more concerning when you consider rural areas. Even though urban clinics often have long waiting lists for mental health providers, rural clinics often have no mental health provider at all.
According to Mental Health America, although there has been a slight decrease in the number of adults who have a mental health condition from 2015 to today, there are still 44 million adults suffering from a mental health condition. Conversely, the number of youth experiencing a mental health condition has increased in the past four years. Data shows that 3.1 million youth (ages 12 – 17) have suffered from at least one major depressive event in the past year, and another 1.1 million are suffering from a substance use disorder. Nationally, only 25% of youth with severe depression receive some form of consistent treatment. Barriers to youth treatment include late recognition in primary care settings and limited coverage of mental health services.
Improving Access to Mental Health Care Services
More than half of those who experience some form of mental illness in a year do not, or in many cases cannot get treatment. Clearly, whether it is a lack of providers, insurance, or general confusion about how to get the necessary treatment, far too many individuals are not getting the help they need. Here are a few initiatives that may help improve access to mental health care services.
- Primary Care Integration – Even in underserved communities, most individuals have access to a primary care physician. The American Psychiatric Association (APA) is supportive of building up capacity for mental health care through additional screening in the primary care setting and flagging patients who need further evaluation by a mental health provider. Many primary care offices are filling the gap with Physician Assistants with mental health specialization. Known as ‘Collaborative Care,’ having access to these front-line providers means additional screening, the implementation of initial treatment plans, and the ability to perform consultation and referral services when necessary.
- Technology – Never to be mistaken for replacing a practitioner, new technologies can be used to expand the reach of existing mental health providers. Video conferencing is being used to overcome the lack of access in underserved communities. Another effective use of technology is the utilization of software-based cognitive behavioral therapy where trial results are demonstrating it as a promising option to in-person therapy.
- Legislative Initiatives – The Centers for Medicare and Medicaid Services (CMS) are encouraging states to create innovative payment methodologies for telemedicine. Evidence exists that shows telemedicine not being reimbursed or reimbursed at a lower level which discourages mental health providers from expanding their services through telemedicine technology. Other legislative opportunities include revising licensure requirements allowing mental health providers to provide services, including telemedicine services, across state lines. Eighteen states have adopted the Federation of State Medical Boards’ compact which expedites licensure for out of state physicians, including psychiatrists. Similar multistate compacts for other mental health professionals are in the early stages of development.
The results of 37 randomized studies published in the Journal of the American Medical Association (JAMA), confirmed that collaborative care is effective in improving short-term outcomes and includes evidence of longer-term benefits. The collaborative care interventions that were included in the JAMA study included a wide range of approaches from face-to-face evaluations to telephone interviews to video conferencing.
Healthcare administrators faced with making critical decisions in providing a broad spectrum of care in the most cost-effective manner will continue considering whether a collaborative care model is appropriate for their system. Data highlighted in an article published by the National Institutes of Health showed that 69% of patients with depression only present physical ailments during their primary care visit. Another study concluded that the higher the number of physical symptoms reported the greater the likelihood of the patient having an underlying mood disorder.
Above all else, mental health care systems are going to continue changing in the face of expanding mental health needs. The opioid crisis is stretching addiction treatment providers to the limit while growing depression and anxiety disorders in our nation’s youth are forcing care systems to develop innovative ways to improve access and reduce the stigmas of mental health care. Currently, there is no consensus on the most effective configuration for a collaborative care approach to meet the mental health needs of a community. In many cases, where it is fiscally viable, additional psychiatric staff in tandem with primary care providers may be the appropriate answer, while in other situations, integrating technologies may be an effective way to expand mental health access.
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