“Thousands of psychologists, therapists, social workers, and psychiatric nurses are currently on a five-day strike against Kaiser Permanente at more than 100 facilities across California, demanding one of the nation’s largest non-profit HMOs devote more resources to mental health services. The union is protesting the services Kaiser is giving to patients insured by the company. It wants Kaiser to increase staffing to reduce the length of time patients must wait for an appointment, to reduce the number of patients sent to non-Kaiser therapists, and to increase the ratio of returning patients to intake patients.” A strike similar to this current strike occurred in 2015 resulting in Kaiser agreeing to make improvements to its clinician-to-patient ratio and other issues. Mental health workers are on strike once more primarily because the union says Kaiser has not lived up to these improvements.
Limited access to mental health care
Currently, the demand for mental health service is greater than the supply across the country, and as a result, many mental health workers are finally speaking out and standing up to this discrepancy. According to The National Alliance on Mental Illness, 43.8 million individuals experience a mental illness in a given year, and there is a shortage of mental health professionals to treat people who are suffering. As a result, wait times have dramatically increased, and mental health workers are forced to spend less time with each of their clients to ensure each client receives some level of care. It is not uncommon for an individual battling depression to have a wait time of 1-2 weeks before they can seek help from a mental health professional and within this wait time, there can be at an increased risk for suicidal ideations and suicide attempts. Another obstacle that is making access to treatment more difficult is the lack of insurance coverage for mental health services. Plans under the Affordable Care Act are required to offer mental health and substance use disorder services however many mental health practitioners chose not to accept insurance because the reimbursement rates were too low. Two-thirds of primary care physicians report difficulty referring patients for mental health care, twice the number reported for any other specialty, according to the journal Health Affairs. Studies have shown that over 24 million individuals with a mental health disorder are not receiving treatment and the southernmost states are known to have the lowest access to mental health treatment.
Barriers to treatment
The five most common obstacles to mental health treatment in the United States include the following:
- No insurance or limited coverage of services
- A shortfall in psychiatrists, and an overall undersized mental health workforce.
- Lack of available treatment types (inpatient treatment, individual therapy, intensive community services).
- A disconnect between primary care systems and behavioral health systems.
- Insufficient finances to cover costs – including, copays, uncovered treatment types, or when providers do not take insurance — the high stigma against mental health, lack of education within the community.
Reasons behind the mental healthcare shortage
It is so easy to blame the lack of services and mental healthcare coverage solely on the insurance companies, and although they do play a large part in this crisis, there are many other factors involved. One of the significant factors involved in the lack of mental health services across the United States is that there is a major shortage of psychiatrists. This field is becoming the leading specialty with the least amount of practicing specialists, and the primary reason is due to the perception that psychiatrists are inadequately paid. Medical students are less likely to apply for a specialty if there is a perception of lower wages compared to other primary care specialties such as family medicine, internal medicine, and pediatrics. Another reason for this shortage is that psychiatrists are more likely to practice in urban areas, leaving rural areas without any access to mental health care, which is most likely why the southern states have the lowest access to mental health care.
Although this is a daunting challenge, there may be light at the end of the tunnel as many medical schools and residency programs are giving incentives for students who choose to go into psychiatry. Telemedicine is another excellent avenue that has opened up multiple channels to allow more individuals in rural areas to seek care for their mental health condition. Hopefully, within time, the gap between supply and demand will slowly close, and mental health services can be provided to all areas of the country without any type of financial discrimination.
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