The National Alliance on Mental Illness (NAMI) estimates that as many as 1 in 5 adults in the U.S. have experienced a mental illness meaning that literally millions of Americans could be suffering from some form of mental illness. That same data showed that as many as 1 in 20 suffers from a serious mental illness.
In addition, many of those receiving or trying to access mental health services experienced some sort of difficulty with treatment, such as delays or cancellations of appointments, difficulty in getting prescriptions and as many as 4.9% of those seeking treatment were simply unable to access the needed care. COVID-19 has had an impact on access to mental health services and may forever change how patients access treatment. Even as the additional health and financial stresses caused by the pandemic have increased anxiety and depression for some patients, access to mental health treatment has shrunk. On a more positive note, more services are becoming available by telehealth which may improve access for some patients.
In 1999, former Surgeon General, David Satcher was the first public health official to address the stigmas related to mental illness (and the resulting public reluctance to pay for treatment) in “Mental Health: A Report of the Surgeon General.” Twenty years after the publication of that report it is somewhat difficult to find substantive changes in this issue. While somewhat improved, stigma is still a barrier to treatment and reimbursement for treatment is still an issue even for those with insurance.
A good estimate on the exact number of patients who cannot or choose not to access mental healthcare is difficult to come by, but the World Health Organization’s estimate is that between 30% and 80% of those suffering with mental illness cannot or will not get care. The range in the estimate itself reflects how difficult it is to assess the number of patients with mental illness and those seeking treatment.
When the stigma associated with mental illness is combined with a lack of knowledge about mental illness, a lack of awareness of available mental health services, an inability to recognize mental health problems and reimbursement issues it is easy to see the reasons for the relatively high estimates on the percentage of untreated mental illnesses.
While we may tend to think of stigma as simply preventing a patient from seeking care, the truth is that the problem is broader and deeper than that. Stigmas associated with mental illness can be a barrier to receiving treatment, but they can also be a barrier while in treatment. There may have been a period of time between the onset of symptoms and the commencement of treatment where the symptoms worsened or intensified while the patient tried to connect with resources. Or worse, patients may encounter healthcare providers harboring their own stigmas about mental illness.
Parents may delay seeking treatment for children and adolescents with mental health issues due to fears about their child being labeled, their own bad experiences associated with mental health treatment as well as concerns about losing custody of their children. Adults may also be reluctant to make certain admissions while in treatment for fear of being labeled or identified by their insurer or even a fear of an involuntary inpatient hospitalization.
The most harmful impact of these stigmas on mental health is that the fear of the stigma can keep people from seeking treatment, but it can also result in difficulties finding employment and housing, bullying and physical harassment, separation from family and friends and the kind of self-doubt and shame that can be significant barriers to recovery.
Stigma against mental illness stems from the same place as most stigmas – a lack of information about the issue. Education and acceptance can make a difference. It can make a difference for the mentally ill and it can help create a culture and a healthcare delivery system that can intervene with the optimal care and treatment when necessary.
All providers, beginning with primary care, need to understand how to recognize the signs of mental illness and connect their potentially unwilling patients with treatment. HealthStream has behavioral health resources that will help staff at all levels better understand mental illness and also helps them gain the skills to respond in an empathic and therapeutic way.
Various organizations are at work to educate the public about mental illness, but education for healthcare providers is important too. HealthSteam’s Care Essentials: Behavioral Health can help improve the quality of care, expand clinical knowledge and skill sets and reduce burnout for those providing mental health services. As demand increases for mental health services it grows even more critical to support your team with the right resources.
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