Significant social problems including rising suicide rates, systemic racism, political turmoil, food and housing insecurities, violence, the opioid epidemic, etc… preceded, and in some cases, were worsening in our communities prior to the arrival of COVID. As COVID spread, every aspect of peoples’ existence on earth was impacted. A National Institute of Health article points out that, “the COVID-19-pandemic-related economic and social crises [led] to huge challenges for all spheres of human life across the globe. Various challenges highlighted by this pandemic include, but are not limited to, the need for global health cooperation and security, better crisis management, coordinated funding in public health emergencies, and access to measures related to prevention, treatment and control.”
#Stayhome [became] an anthem for everyone, writes Barbara Duriau, a Facebook poster and Administrator of the history-making, COVID-inspired global community group, “View From My Window” (VFMW). In her post announcing the discontinuation of the group this week, she goes on to explain that she, like the 3.8 million members of the group, “…was surrounded by millions of people, virtual but isolated. Another member of the group describes that ‘VFMW took me out of fear and into hope. It gave me something bigger than myself to think about. It opened my eyes to other ways of life, to other seasons, to others homes and hearts, to others suffering and dreaming, and to others perspectives & experiences of what we were all going through together. It was (& still could be) a beacon of light in some dark times. Put simply, I miss it.’
In her 1995 article, Hearing the Difference: Theorizing Connection, Carol Gilligan, an American feminist, ethicist, and psychologist, best known for her work on ethics in community and relationships, states “Theorizing connection as primary and fundamental in human life leads to a new psychology, which shifts the grounds for philosophy and political theory.” Atul Gawande, a surgeon, observes, “Human beings are social creatures. We are social not just in the trivial sense that we like company, and not just in the obvious sense that we each depend on others. We are social in a more elemental way: simply to exist as a normal human being requires interaction with other people.”
In many ways, the effects of isolation continue. Many observe that, in part, general cynicism and animus that seemed to be characteristic of our societal adjustment to COVID precautions and defense still remains. Regardless of where they live, nearly half of Americans (47% overall) say the pandemic has divided their communities; relatively few (13%) say it has brought people together. And many see a long road to recovery, with about one-in-five saying life in their community will never get back to the way it was before the coronavirus outbreak.
In the face of our mental health emergency, we turn to the medical and behavioral health system as our primary hope for addressing individual distress and communal discord. Despite, and because of, its complexity and challenges, the medical and behavioral health system has been struggling to meet the needs of people facing the current mental health crisis. Here are some of the most common reasons:
One of the biggest challenges facing the healthcare system is the high cost of care. Healthcare is expensive, and the costs are constantly rising. The United States spends more on healthcare than any other developed country, both as a percentage of GDP and on a per capita basis. This is due to a number of factors, including the high cost of medical technology, prescription drugs, medical devices, hospital stays, the increasing complexity of medical care, and the aging population. There is a lot of waste in the system, and this drives up costs.
Another challenge is the fragmentation of the healthcare system. The healthcare system is complex, disorganized, and inefficient. There are many different players in the system, including hospitals, doctors, insurers, and pharmaceutical companies. There are many different types of insurance plans, and each plan has its own set of rules and benefits. This can make it difficult for patients to navigate the system and get the care they need.
Adding to this, the healthcare system is facing a shortage of providers, especially in primary care. This is due in part to the low pay for primary care doctors, the high stress of the job, and the increasing number of people who are uninsured or underinsured.
The system is also inequitable. Health inequities are a serious problem in the United States. They can lead to poorer health outcomes for people who are already at a disadvantage. It is important to address these inequities so that everyone has the opportunity to live a healthy life. There are many factors that contribute to health inequities, including race, ethnicity, socioeconomic status, and geographic location. Not everyone has access to quality healthcare, and those who do often have to pay high prices.
Finally, the emerging trend of private equity firms acquiring healthcare systems must be considered. It is often not in the best interest of patients, staff, or the community for private equity companies to own hospitals.:
- First, private equity companies are focused on making a profit, and they may make decisions that are not in the best interest of patients or the hospital staff. For example, they may cut costs by reducing the number of nurses or doctors, or by closing down essential services.
- Second, private equity companies often have little experience in the healthcare industry, and they may not have the expertise to manage a hospital safely or effectively. This can lead to problems such as poor patient care, financial mismanagement, and regulatory violations.
- Third, private equity companies often use debt to finance their acquisitions, which can make the hospitals they own more vulnerable to financial problems. If a hospital is unable to make its debt payments, it may have to file for bankruptcy, which can disrupt patient care and put jobs at risk.
The status of healthcare in America today is multifaceted and convoluted. On the one hand, the United States has some of the best medical care in the world, with cutting-edge technology and highly skilled doctors. On the other hand, the healthcare system is also expensive and fragmented, and many people struggle to afford the care they need.
More specifically, availability of necessary quality mental health care is severely lacking. In a March 23, 2023 article entitled, “Medicaid Data Show Wide Differences in Mental Health Care in the United States”, the National Institute of Mental Health writes, “the findings highlight the nationwide use of emergency departments for mental health care, while emphasizing wide variations in rates of use between states and between mental disorders. The frequent use of emergency services for mental health care shown in this study might, in some cases, indicate a high degree of unmet need or a lack of access to outpatient mental health services.”
There are a number of reasons why access to mental health care is so limited, especially in states like Pennsylvania. Like healthcare in general, the most common reasons for the inadequacy includes cost, lack of providers, and inefficiency. Adding to these circumstances, are the problems of parity and stigma.
Mental health parity is the idea that people with mental health conditions should have access to the same quality of care and coverage as people with physical health conditions. Parity laws require health insurance plans to cover mental health and substance use disorder (SUD) benefits in the same way they cover medical and surgical benefits. Though the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health insurance plans to provide parity for mental health and SUD benefits, there are some exceptions to these requirements. For example, MHPAEA does not require health insurance plans to cover inpatient mental health care for more than 15 days per year. Additionally, MHPAEA does not require health insurance plans to cover all mental health and SUD services. Many insurance plans do not cover mental health care, or they only cover a limited amount of mental health care. This can make it difficult for people to afford the care they need.
There is still a lot of stigma associated with mental illness, which can prevent people from seeking help. People may be afraid of being judged or discriminated against if they talk about their mental health problems. First, stigma can lead to shame and embarrassment. People may feel ashamed of their mental health condition and may not want to talk about it. Second, stigma can lead to fear of discrimination. People may worry that they will be treated differently if they disclose their mental health condition. They may worry that they will be fired from their job, denied housing, or even shunned by their friends and family. Third, stigma can lead to self-stigma. People may internalize the negative stereotypes about mental illness and believe that they are not capable of living a normal life. They may also believe that they are to blame for their mental health condition and that they should be able to “just get over it.”
These are just a few of the reasons why access to mental health care is so limited. It is a complex and challenging issue, and there are no easy solutions. Despite these challenges, there are also some positive trends in the healthcare system. There are a number of people working to improve access to mental health care and make it more affordable, accessible, and equitable.
The Affordable Care Act assisted in helping to reduce the number of uninsured Americans. It has had a number of benefits for Americans, including expanding health insurance coverage, improving the quality of care, and reducing the costs of health care. Another piece of legislation positioned to greatly improve the state of mental health care is The Consolidated Appropriations Act, 2023. It is an omnibus spending bill that includes a number of provisions that will impact mental health and substance use disorder treatment. It was signed into law by President Biden on December 27, 2022.
Some of the most notable provisions include: Expansion of Medicaid coverage. The bill expands Medicaid eligibility to cover more low-income adults, including those with mental health and substance use disorders. This will help to ensure that more people have access to affordable treatment. It also Increases funding for mental health and substance use disorder programs. The bill includes $11 billion in new funding for mental health and substance use disorder programs. This funding will be used to support a variety of programs, including prevention, treatment, and recovery support services. Additionally, The bill helps reduce barriers and makes it easier for people to access mental health and substance use disorder treatment through telehealth. This will be especially helpful to people in rural areas.
The bill supports research and includes $1 billion in new funding to support a variety of research projects, including studies on new treatments and prevention strategies to support mental health and recovery from substance use disorders. Furthermore, the bill includes $10 million in new funding for innovation programs in the mental health field. This funding will be used to support the development and implementation of new mental health interventions and clinical programming.The Consolidated Appropriations Act, 2023 (Pub.L. 117–328, 147 Stat. 814, enacted December 29, 2022) includes a number of provisions that impact community mental health.
One provision provides $10 billion in funding for mental health services, including $5 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA) and $5 billion for the Department of Health and Human Services (HHS). This funding will be used to support a variety of programs, including:
- Crisis stabilization services
- Mobile crisis response teams
- Community-based mental health treatment
- Suicide prevention
- Substance abuse treatment
Another provision provides $1 billion in funding for the Children’s Mental Health Services Block Grant (CMHSBG). This funding will be used to support a variety of programs, including:
- Early intervention and prevention services
- School-based mental health services
- Pediatric and adolescent inpatient and residential mental health services
- Family support services
The Consolidated Appropriations Act of 2023 includes $50 million in new funding for workforce development programs in the mental health field to address the staffing shortage. This funding will be used to train new mental health professionals and support the professional development of existing mental health professionals. The bill also has a number of provisions that will increase systemic collaboration and efficiency by supporting the integration of mental health care with primary care.
The legislation provides $5 million in new funding for coordination programs in the mental health field. This funding will be used to support the coordination of mental health resources, personnel, and services across different settings and systems. These provisions include: Funding for training and technical assistance for primary care providers on how to integrate mental health care into their practices, funding for research on the effectiveness of integrated mental health care, and support for the development of sustainable models of integrated mental health care. These provisions are designed to help primary care providers better identify and treat mental health conditions in their patients. They also aim to improve access to mental health care by making it more readily available in primary care settings.
Integration of mental health care with primary care can have a number of benefits for patients. It can lead to earlier diagnosis and treatment of mental health conditions, which can improve outcomes. It can also reduce the stigma associated with mental health care, as patients are more likely to seek help if they can receive it in a familiar setting. Integration of mental health care with primary care can also be beneficial for providers. It can help them to more cohesively work together in better understanding and managing the mental health needs of their patients. It can also save time and money, as providers can address both physical and mental health needs in a single visit.
As unprecedented rates anxiety, depression, violence, substance misuse, overdoses, and suicide continue, global, national, and local communities must continue to work toward recuperating and healing. The efforts to (re)gain peace and mental health should be intentional and organized. Official structures such as The Consolidated Appropriations Act of 2023 are long overdue and much needed positive steps for establishing and maintaining individual and community mental health through continuing expansion of access to care, improvement in the quality of care, as well as supporting research, workforce development, innovation, and meaningful coordination of resources.
Gilligan, C. (2003). Hearing the difference: Theorizing connection. Anuario de Psicología, 34(2), 155–161.
Medicaid Data Show Wide Differences in Mental Health Care in the United States: https://www.nimh.nih.gov/news/science-news/2023/medicaid-data-show-wide-differences-in-mental-health-care-in-the-united-states
Opioid crisis settlements have totaled over $50 billion. But how is that money being used?: https://www.cbsnews.com/news/opioid-crisis-settlements-have-totaled-over-50-billion-how-is-that-money-being-used/
Panneer S, Kantamaneni K, Palaniswamy U, Bhat L, Pushparaj RRB, Nayar KR, Soundari Manuel H, Flower FXLL, Rice L. Health, Economic and Social Development Challenges of the COVID-19 Pandemic: Strategies for Multiple and Interconnected Issues. Healthcare (Basel). 2022 Apr 21;10(5):770. doi: 10.3390/healthcare10050770. PMID: 35627910; PMCID: PMC9140679.
Based on a piece originally posted by Theresa Drass on Q’Hubo, May 2023
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