When the flu pandemic hit the United States in 1918, medical care was a privilege reserved for the elite. But the widespread outbreak of a deadly virus did not adhere to social hierarchies. It highlighted an inadequate system that too few could access.
As a result, forward-thinking people built a public health infrastructure from scratch — one which we still see the critical value of today.
More than a hundred years later, in the midst of the novel coronavirus pandemic, we face the consequences of another inadequate and inaccessible system: mental health care. The psychological pressures that Covid-19 has brought — isolation and physical distancing, fast-rising unemployment and economic loss — have triggered what amounts to a secondary pandemic for millions of Americans. We need a mental health care overhaul.
Help can’t come soon enough. According to research published in the Journal of the American Medical Association, in April of this year, about three times as many adults reported psychological distress as in 2018. That same month, texts to the federal government’s Disaster Distress Helpline increased by almost 1,000%.
As the pandemic has continued, parents, especially mothers, have reported feelings of grief, fear and loneliness as they balance schooling their children and maintaining full-time jobs. Furthermore, reports of domestic violence and abuse are increasing around the world.
The killings of George Floyd, Breonna Taylor, Ahmaud Arbery and so many others have increased anxiety and depression among the Black community, compounding the experience of trauma and psychological violence caused by systemic racism.
We must address this massive crisis in mental health. However, to make meaningful changes, we first need to examine the failure of our current system.
Historically, society has denigrated mental health, perhaps because the condition of the mind seems less “real” or measurable by established standards. This notion largely segregated mental health from the medical system, undermining our investment in mental health treatment and caregiving to this day.
Although nearly one in four American adults experience a mental health condition each year, according to the National Institute of Mental Health, fewer than half get the care they need, per Mental Health America.
One reason is that there are not enough providers. In the United States, there were only 34 psychologists for every 100,000 people, according to the American Psychological Association in 2012. There are even fewer psychiatrists — mental health specialists who prescribe medication; just 13 for every 100,000 people in the US, as of 2018.
For those seeking care, finding the right treatment can feel harrowing. All too often, people with insurance are given a 1-800 number on the back of a card to find mental health care services only to get the runaround.
Stale provider lists often include “ghost networks,” suggesting providers that don’t, in fact, take insurance, have retired, or even have died — which confuses and discourages patients from pursuing resources.
One study found that as of 2017 patients were over five times more likely to need to go out of network to receive mental health care, than physical health care. It’s not hard to imagine the tremendous impact this has on patients’ ability to get help.
We need a mental health care system fit for the challenges of the 21st century. The question is: How do we build it?
The first step is to recognize that mental health is a key component of overall health. This begins in the doctor’s office, where mental health screenings should become as routine as taking blood pressure.
Assessing mental health as part of a standard check-up would help primary care physicians proactively identify mental health conditions, the first step for patients to get the care they need.
With an understanding of patients’ clinical needs and information on providers’ clinical expertise — technology can match patients to mental health care based on their needs and preferences. Some patients may want in-person care; others would opt for home tele-appointments or digital care through a secure app.
This structure would begin to make more efficient use of limited specialists and get people to that care more quickly.
Using a patient’s baseline mental health assessment, mental health providers would be able to set treatment goals and collaborate with a patient’s care team, including their primary care doctor.
They would also be able to track the patient’s progress and know whether they are getting healthier from treatment. This information would be kept secure, just as with electronic medical records.
Still, insights and infrastructure alone won’t fix a broken system. To truly support ubiquitous access to care, we need to build a system where providers are paid more to take insurance. In 2017, mental health providers were reimbursed 24% less than primary care physicians.
It’s no coincidence that during the same year, patients found it increasingly difficult to find providers who took their insurance. Because of low reimbursement rates, it can be more lucrative for a mental health provider to work directly with patients who can afford to pay out of pocket than to work with insurers.
To address this disparity, health insurance companies need to pay providers more to help patients get healthy. Through the same technology used to measure patients’ health and match them to the right care, insurers can begin to learn about the quality of care a provider delivers.
In the immediate term, health insurance companies can use aggregate, non-identifiable patient data to pay providers more money for delivering great care. Over the long term they will save money.
Studies show that improving patients’ access to mental health care reduces overall costs for health plans, particularly around chronic physical conditions.
This would be a win for health insurance plans, providers, and most critically, patients. People with mental health conditions would get healthier. Health insurance plans would save on long-term costs. And providers would earn more money to practice patient-centric care.
We know that making these changes won’t be easy, but they are critical. Mental health conditions are not one-time experiences. They are often chronic conditions that present different needs at different times. We must make sure patients can access the care they need, especially during the most difficult moments, so they can stay healthy throughout their lifetimes.
Just as the 1918 flu showed us that access to medical care can’t be limited to the few, today’s pandemic confirms that we can no longer wait for a quality mental health care system. We have the knowledge. We have the technology. We have the capabilities. Now, we need the courage to act.