Year: 2017
Type: editorial
Abstract: Nearly one in 5 adults in the United States has a mental health condition: that represents more than 40 million US adults.1 And one in 2 US adults will develop a mental health condition at some point in their lives.2 These statistics cut across age, gender, race and ethnicity, sexual orientation, and geography. If mental health conditions do not affect us individually, they affect us personally: a family member, a friend, a co-worker, or a neighbor may well be that one person in 5. Those of us who are practicing midwives no doubt see these numbers reflected as well in the women we care for. Mental Health America is a nonprofit organization established in 1909 to address the needs of those living with mental illness and promote the overall mental health of Americans. The organization produces an annual survey on the state of mental health in this country, compiled from current publicly available data from the 50 states and the District of Columbia. The data are used to rank states and the District on a number of indicators, and one can follow changes in these indicators over time. The State of Mental Health in America 2017 report indicates that the current prevalence of any mental illness is 18.29%; this category is defined as a “diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder,” and includes mild, moderate, and severe mental illness.1 Moreover, 8.5% of US adults have a substance use or alcohol problem. Nearly 4% of adults report serious suicidal thoughts. Eleven percent of young people aged 12 to 17 years report having had a major depressive episode in the past year, and more than 5% report having a substance use or alcohol problem.1 And while some states may rank better than others on some indicators, there are no states immune to the need to address mental illness and associated conditions. It should be obvious that a condition with a prevalence of nearly 20% in a population is a major health problem, yet mental illness is still thought of as a hidden condition, requiring more diligence in screening people for this health problem. The prevalence of mental illness alone meets the first of several principles that underlie the practice of screening for undiagnosed health problems. But prevalence is not the only criterion that must be met if screening for disease is to provide a benefit in reducing that disease burden for individuals and for communities. Having valid and acceptable screening tests is an important factor. And having accessible and acceptable treatments for the condition for which one is screening is another. These public health principles for the practice of screening for disease have stood for 50 years and still resonate today.3 Perhaps most important, these principles require that “facilities for diagnosis and treatment … be available.”3 After all, what is the benefit of identifying disease when the person who has the condition cannot access proper diagnosis and treatment? It is in the availability of and access to care for mental illness that the State of Mental Health in America 2017 survey highlights how far we are from where we should be. The 2017 survey reports that 56.5% of adults with any mental illness received no care in the past year. Of those adults with mental illness who did get some treatment, more than 20% reported unmet needs. And 64% of youth with major depression did not receive any mental health treatment; only 22% received consistent treatment.1 Why is this gap so huge? For one, 17% of US adults with a mental illness (more than 7.5 million people) remain uninsured.1 While this represents an improvement from 2010 (when the Patient Protection and Affordable Care Act [ACA] was signed into law), it nonetheless tells of a persistent uninsured population, which will no doubt grow if the law mandating insurance coverage is repealed or substantially changed. The State of Mental Health in America 2017 report notes that state and local policies have a major impact on access to services, and state-by-state data on access to care vary widely, from only 2.7% of adults with mental illness who are uninsured in Massachusetts to more than 28% in Nevada.1 Significant improvements in access to care were noted in states that implemented the ACA and other policy changes to improve access to mental health care.1 Working within states to improve policies for access to mental health care and coverage will be critical to closing the coverage gap. But having insurance coverage does not guarantee access to needed care. The availability of mental health professionals to respond to the needs of people with mental illness is a critical piece of having access to treatment. The State of Mental Health in America 2017 survey defines mental health care providers as “psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and nurse practitioners who specialize in mental health.”1 Yet despite the broad range of professionals who could provide care, there is only one mental health care provider for every 529 individuals nationwide, ranging from one for 200 in Massachusetts to one for 1200 in Alabama.1 More than 4700 areas across the United States are designated mental health professional shortage areas,4 casting a shadow across the entire nation. Many health professionals know too well the bottom-line effects of such shortages: we may conscientiously observe our patients for risk factors and signs of mental illness, and provide screening tests for depression and other disorders, but once we have identified a problem, we often find that local, affordable, accessible mental health professionals to provide follow-up diagnosis and treatment are simply not available. What can we do? The political engagement and activism that have followed the 2016 presidential election in this country are notable on both sides of the partisan divide.5 Our own professional organization, the American College of Nurse-Midwives, has mobilized many of its members to action in defending access to care for our patients, from maternity care to family planning and preventive care. That activism must include advocacy for mental health care, from financial coverage to the training and support of mental health professionals to care for our patients in need. While the political divide seems glaring these days, both the 2008 Mental Health Parity Act, which required parity for mental health services in insurance coverage, and the 2016 21st Century Cures Act, which provided for better enforcement of parity requirements, did have bipartisan support.6 A graphic in the State of Mental Health in America 2017 report gathered information about political party affiliation in the 50 states and the District of Columbia and combined it with the rankings on access to care. The 10 states with the best access to mental health care (albeit not universal access) were an equal mix of states that leaned Democratic, those that leaned Republican, and those in the middle.1 These observations might suggest that in these days of political partisanship and division, it is possible to come together as a nation over support for expanding access to mental health services. On the other hand, the same graphic also showed that access in the middle 20 and bottom 20 states was markedly divided across political party affiliation, underscoring that we still have a long way to go. But we can at least start by ensuring we know the issues in our own states, as well as nationally, that we work with organizations best suited to identify practical and pragmatic solutions, on a local as well as national level, and that we use our personal and professional expertise and political energy to advocate for improvements in access to mental health care. Taking action, individually and professionally, to bring about systemic change can only help our patients and the broader population of family members, friends, co-workers, and neighbors who need our advocacy to improve mental health care.
DOI: 10.1111/jmwh.12700
Author: Patricia Aikins Murphy
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W2768650217