It is unfortunate that it takes a tragedy, such as actor Robin Williams' recent suicide, for Americans to rally around advocacy efforts to improve mental healthcare services. National Mental Health Awareness Month is in May, but October 5-11 is National Mental Health Awareness Week, which includes National Depression Screening Day on October 10. In my primary care practice, approximately 75% of each visit is spent on mental health issues ranging from minor situational reactions to deep-rooted psychiatric conditions. Even if I am not the provider managing these conditions, I still must deal with their manifestations every time a patient with mental illness presents.
The statistics from the National Alliance on Mental Illness (NAMI) are striking:1 1 in 4 adults suffer from mental illness in a given year; 1 in 17 have serious mental illness; approximately 20% of adolescents ages 13 to 18 years have a severe mental illness in a given year; and 14.8 million (or 6.7%) of American adults live with major depression. Many of these individuals also struggle with addiction disorders. Even more troubling are the low numbers receiving adequate treatment. Approximately 60% of adults and almost 50% of youth ages 8 to 15 years with a mental illness received no mental health services in the previous year. And, as expected, health disparities among minority groups were even more dismal, with utilization of mental health services one-half the rate of Whites for Black and Hispanic Americans and one-third for Asian Americans.1
Stigma is attached to mental illness in many cultures. Individuals often struggle alone trying to function in socially acceptable ways while secretly fighting inner “demons.” Others more openly exhibit signs and symptoms of mental illness. Individuals are not always aware of or do not acknowledge mental illness and so do not willingly seek treatment. Individuals create personal barriers to care, believing they can solve the problem without professional help. And barriers exist for those who do seek care. The high cost of mental healthcare services, mental health providers electing not to participate in insurance plans, and cuts in state funding have increased financial barriers and have also contributed to absent or decreased access.2
In 2014, regulations from the Affordable Care Act (ACA) mandated that new small group and individual market plans cover mental health and substance use disorders services on parity with medical and surgical benefits. Healthcare professionals and the public need to stay informed as new regulations of the ACA are implemented. NAMI offers a list of “5 signs your plan may be violating parity requirements.”3 Certain plan rules that differ for mental healthcare services compared with other kinds of healthcare are red flags for consumers and providers. Examples include: the patient has to pay more or has fewer visits for mental health services; has to obtain permission for coverage of mental health services; is denied services because they are deemed not “medically necessary;” cannot find in-network mental health providers who are taking new patients; or plan will not cover residential mental health, substance use treatment, or intensive outpatient care.3
The ultimate goal
The scarcity of qualified mental healthcare services is a reality nurse practitioners deal with every day. When we refer patients, they expect our help in navigating the healthcare system for access to mental health services. Join the campaign this month (and every month) to raise awareness about mental health illnesses. Participate in National Depression Screening Day (www.mentalhealthscreening.org). Small efforts contribute to solving larger problems, and the ultimate goal is a healthier population in body, mind, and spirit.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, DNPNAP
EDITOR-IN-CHIEF [email protected]
1. National Alliance on Mental Health (NAMI). Mental illness facts and numbers. 2013. www.nami.org/factsheets/mentalillness_factsheet.pdf