AAs the pandemic continues to disrupt lives in the United States, a staggering number of Americans are turning to their primary care physicians for help with sometimes overwhelming mental health issues. Yet primary care physicians like us have nowhere to turn when it comes to finding mental health care providers for them, and our patients often suffer without the specialized care they need.
It’s time for the American Medical Association to take decisive action and declare a national mental health emergency.
More than 40% of Americans report symptoms of anxiety or depression, and emergency rooms are inundated with psychiatric crisis patients. Left untreated, these problems can have devastating consequences. In 2020, an estimated 44,800 Americans lost their lives by suicide; among children aged 10 to 14, suicide is the second leading cause of death.
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Finding mental health care providers for patients is a difficult climb, in part because there is no centralized process for it. Timely mental health services are surprisingly hard to come by, even in Massachusetts, where we live and work, which has the most psychologists per capita. Wait lists for therapists can be longer than six months for adults, and even longer for children.
Knowing that our patients need urgent care, we direct them to an online magazine, Psychology Today, which offers a directory of therapists in private practice – although the information is often out of date – as well as paid advertisements.
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Patients also search insurance directories, which can be so littered with inaccuracies that they have been called shadow networks. This forces patients to seek out, one phone call at a time, an available and affordable provider who calls back – a process known to be plagued by racial and class bias.
Our patients’ experiences reflect a national survey conducted by the National Alliance on Mental Illness. It found that 55% of participants contacted a psychiatrist only to learn that the doctor was not accepting new patients, and 33% could not find a single mental health care provider who accepted their insurance. Low reimbursement rates prevent network therapists from making a decent living, leading many mental health providers to choose private practices, where high fees put services out of reach for many.
Given these barriers to care, it’s no surprise that NAMI estimated in 2017 that “nearly half of the 60 million adults and children living with mental health issues in the United States are treatment ”- and that was before the pandemic, which multiplied. mental health needs.
WADA has declared emergencies in the past. In 2016, he declared gun violence “a public health crisis” based on around 30,000 gunshot deaths each year. In 2020, WADA recognized that racism is a “threat to public health”.
Recognizing the growing need for psychiatric care in May 2021, the CEO of Children’s Hospital Colorado declared a state of emergency for children’s mental health after emergency room visits for anxiety and depression increased 72% in one year. At the time, the hospital was experiencing a shortage of psychiatric inpatient beds and the risk of suicide was the main reason for emergency room visits.
Do public emergency declarations make a difference? Measuring this is difficult. But by declaring a national mental health emergency, WADA would highlight this urgent problem that is exploding in the shadow of the pandemic.
Other groups of health professionals wanted WADA to take this step. In May, delegates from the American Academy of Pediatrics and the American Psychological Association called on WADA to approach the problem collaboratively, offering a 10-page brief on policy and funding changes to improve health. access to mental health care. While about 30 health groups approved and initiated the work, WADA refused, agreeing only to “encourage efforts” to increase access for children. The association did not mention the crisis affecting adults or call the situation what it is: a medical emergency.
By declaring a mental health emergency, WADA could galvanize health administrators and spur the innovation needed to improve the existing mental health system. When Covid-19 was labeled a pandemic, America’s healthcare infrastructure quickly adapted to handle the deluge of infections. The leaders mobilized resources with agility and creativity. They have redeployed staff, built overflowing field hospitals and intensive care units, and postponed routine surgeries and care to conserve resources and minimize hospital transmission of Covid-19. With the right framing and a sense of urgency, similar things can happen for the mental health care system.
To be clear, this is all WADA’s path: In addition to the devastating toll of suicides and overdoses, untreated mental illnesses worsen heart outcomes, increase Covid-19 mortality, and shorten lifespan. Mental illness in adults also directly affects the health of children, leading to poor health outcomes from one generation to the next.
Some solutions to the mental health care crisis can be relatively straightforward. A centralized website where patients could find therapists who accept their insurance – which private citizens have done to improve access to Covid-19 vaccines – would help.
But a large-scale boost is needed. WADA has the power and the scope to initiate these changes, if it calls it the way doctors and patients across the country see it: It’s an emergency, period.
Susan Hata is a pediatrician and intern at Massachusetts General Hospital, where Thalia Krakower is an intern. Both are Public Voices Fellows from the OpEd project.
