Good morning! Today on My Brain’s Not Broken we have a guest post from the team at Prairie Health, a company founded to make mental health care more accessible and effective, about some of the ways that mental healthcare can be improved from their perspective. We discussed some of these things during our recent conversation on Instagram Live – up on my Instagram page now!
1 in 5 adults in the United States suffer from a mental health condition, yet current treatment doesn’t work for most of them. Over 86% of patients with anxiety disorders do not get adequate treatment. The problem starts with access. Most individuals who need mental health services either don’t seek it out or cannot access a qualified provider. Since seeking care is so stigmatized, many don’t seek help. In addition, there aren’t enough trained providers to meet the significant demand. The challenge with finding a provider that accepts insurance or has an affordable rate only compounds this problem. Finally, when individuals are able to get in the door, the nature, quality and effectiveness of services vary widely.
Problem I: Stigma
Although over 20% of the US population deals with some form of mental health concern, stigma around the topic of mental healthcare — and oftentimes medication — is still pervasive. There are two types of stigma associated with mental illness:
- Social stigma: the prejudiced attitudes towards mental illness by those around you
- Self perceived stigma: the internalized stigma that a person with mental illness suffers from
Stigma is one of the biggest barriers to people seeking treatment, with 8/10 employees with a mental health condition reporting that they feel shame and stigma that prevents them from seeking treatment. The consequences of this can be serious — leading to greater reluctance to seek out care, social isolation, worse mental health outcomes, and increased feelings of shame and self doubt.
Combating stigma can be difficult and there is no one solution. Here are four things you can do to reduce the stigma associated with mental health:
- Know the facts. Educate yourself and the people around you about the prevalence of mental illness and actively challenge myths and stereotypes.
- Be aware of your own attitudes and behaviors. Start correcting inappropriate language (e.g. Correct people when they say things like “this is so depressing,” and inform people about the harm caused by using words such as “psycho,” “schizo,” or “OCD” to describe behaviors; language like this trivializes the suffering people with these conditions experience).
- Participate in and share mental health advocacy campaigns, or create your own advocacy campaign on social media.
- Remember that you aren’t alone: many people experience mental illness. Make sure to find support when you need it. Organizations like the National Alliance on Mental Illness (NAMI) offer resources for anyone in need. You can also check local government resources in your area (many of these resources are available for free) or check for local support groups.
Problem II: Access to Care
Not enough trained providers to meet demand
The shortage of psychiatrists and other mental health professionals is arguably the biggest barrier to people accessing care. In a survey conducted by Prairie Health, an online mental health care service, individuals shared that the hardest part about seeking treatment for them was finding a psychiatrist or therapist. They found that it required calling an average of 30 therapists (with only 25% actually responding) for people to even get an appointment.
This issue is even more acute when the individual is in need of medication or is currently on medication. The FDA recommends that individuals starting on antidepressants have at least weekly face-to-face visits during the first 4 weeks of treatment, visits every other week during the next 4 weeks, a visit at 12 weeks of treatment, and visits as indicated clinically beyond that point (additional contact by telephone is encouraged between face-to-face visits).
However, 80% of patients have no contact with a mental health provider during the first 4 weeks after starting medication. In fact, currently, the average frequency of face-to-face (video or in-person) contact with a mental health provider after starting an antidepressant is once every 12 weeks.
Aside from a lack of providers, another problem facing people seeking mental healthcare is the cost. The average cost for a psychiatrist appointment can be over $400 and, 45% of psychiatrists don’t accept insurance. As a result, many individuals cannot seek care.
The rise of behavioral health services via tele-health can help address the growth of mental health challenges and provide people with quicker access to providers. Telehealth promises to improve access to care, acceptance of care, and medication adherence. Most tele-health platforms and apps allow you to book appointments directly, with wait times less than a week.
Most telehealth platforms offer lower costs for appointments without compromising quality, with therapy appointments ranging from $65 – $250 and psychiatry appointments ranging from $200 – $350.
Make sure to check local providers in your area as well as some that can offer sliding scale rates!
Problem III: Effectiveness of Treatment
The problem with current mental healthcare is that treatment for depression and anxiety was created under the assumption that “one size fits all”. This is especially true in the case of psychiatric medication; many psychiatric medications were developed before diversity was a requirement in clinical trials. As a result, corresponding dosing guidelines may not be appropriate for women and people of color — among many others.
This has led to inappropriate dosing guidelines and worse outcomes in many groups. Most patients have to try multiple medications to find one that works — this presents a problem, as they must wait weeks for their antidepressants to start working. Between waiting for a medication to work and switching to a new one, treatment can take months or longer. Over half of these patients stop taking their medications as prescribed on account of side effects of ineffectiveness; this results in worse outcomes and higher risk of deterioration or relapse.
Solving this problem is hard because each individual reacts differently to different treatments. Genetic testing is a step towards solving this problem. It allows providers to make more informed decisions based on a patient’s biology. This is especially important for people who are considering going on medication or people who have tried medication in the past but experienced severe side effects. Genetic testing has been shown to increase effectiveness of treatment and reduce risks of associated side effects.
You can get genetic testing by either speaking to your current psychiatrist and looking at your options, or finding services that offer genetic testing as part of their service (such as Prairie Health).
Mental healthcare in the U.S. is far from perfect. We still have a lot of work to do to reduce stigma, and make care more accessible and effective. However, by expanding the conversation around mental health and investing in new technologies and services, we can change the narrative and make better mental healthcare a reality.