We are all shocked when we see news stories of multiple people being killed by someone who seems to have gone off the deep end. While these events are extremely rare, it is a true tragedy to have them happen at all. It is often found that the guilty parties were suffering from some mental illness. These are the extremes of mental illness. However, milder forms of mental illness, such as anxiety and depression are very prevalent in the U.S. The unfortunate reality is that for many of these patients, they just cannot get mental healthcare even if they want access to it.
How big is the problem?
According to a survey of physicians on Sermo, the number one social network exclusively for physicians, approximately 84% of the doctors polled believe there is a mental healthcare crisis in this country. Often times, the primary care physician is left to care for these patients whom they may not feel comfortable taking care of, just because they cannot get an appointment for the patient with a psychiatrist. I often times have a patient who I believe needs to see a psychiatrist but is unable to get an appointment for up to 6 months. If a patient is having a mental healthcare urgency, they usually end up in the ER for lack of access to outpatient healthcare. But, psychiatrists are not to blame. This is rather due to a broken system that is in need of major reforms.
Why is there a mental healthcare access crisis in the U.S.?
1. In the 1960’s, psychiatric hospitals closed their doors, making inpatient services very limited. Many of the chronically mentally ill that should be treated as inpatients no longer have that option. They are forced to be treated in outpatient settings.
2. Psychiatrists were being reimbursed dismally, especially for their Medicare and Medicaid patients. They were unable to stay in practice due to rising costs and minimal payments. Therefore, many psychiatrists stopped accepting these government insurances.
3. The private insurance sector followed with low reimbursements. Many psychiatrists dropped all insurances all together and went cash-only to stay in business. It has been estimated that 50% of psychiatrists in the private sector do not accept any insurance and see patients on a cash only basis.
4. There are simply not enough psychiatrists to treat all those with mental illnesses.
5. Another great contributing factor to the mental healthcare crisis in this country is the lack of appropriate insurance coverage. Mental health services are often covered via a different route than traditional medical services.
The Stigma With Mental Illness
Sometimes, the lack of getting needed mental healthcare comes from within the patient. One of the reasons that contribute to this lack of mental health services for patients is the stigma associated with mental illnesses. People are often labeled “crazy.” Time and again it has happened to me that I suggested to a patient that they seek an evaluation from a psychiatrist, and they refused because they know they are not “crazy.” Additionally, when symptoms are attributed to diseases such as anxiety, depression, obsessive-compulsive disorder, post-traumatic stress disorder, and many more, they are no longer seen as medical conditions. People are often told to just “get over it.” Many patients are generally frustrated because they are not doing well, and people don’t believe they have a “real” medical disease. However, these diseases are indeed real, and treatments are available. Many have a hard time with employers qualifying for short-term disability because of mental health diagnoses.
Mental illness comes in many forms. It is as equally disabling and life afflicting as other medical diseases. We need to address this crisis and help those suffering these diseases get the help they need. Everyone needs to understand that mental illness is not a choice or something a patient can just wish away. More trained providers are needed, with doctors as team leaders, and insurance companies need to cover services. When people who are suffering common diseases are unable to get help or are made to feel embarrassed to ask for it, that is a true healthcare crisis.
How do you handle situations when your patients have psychiatric needs you are struggling or unqualified to meet?
Dr. Linda Girgis MD, FAAFP, is a family physician in South River, New Jersey. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year. Over the course of her practice, Dr. Girgis has continued to earn awards and recognition from her peers and a variety of industry bodies, including: Patients’ Choice Award, 2011-2012, Compassionate Doctor Recognition, 2011-2012. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.