As challenges like Covid-19 and addressing racism continue to hurt Americans’ mental health, it brings new urgency to some of the long-standing issues like the cost of accessible care. Here’s what you need to know.
The cost of mental health
Spending on mental health treatments and services reached $ 225 billion in 2019, according to an Open Minds Market Intelligence report. That number, which is up 52% since 2009, includes spending on things like therapy and prescription drugs as well as stays in psychiatric or addiction rehabilitation facilities.
It does not take into account indirect costs, such as lower labor market participation rates and lower productivity. In fact, depression alone is estimated at $ 44 billion in lost workplace productivity, according to a recent report from Tufts Medical Center and One Mind at Work.
And access to care can be too expensive – even more than the cost of physical health. A traditional one-hour therapy session can range from $ 65 to $ 250 for people without insurance, according to the GoodTherapy.org therapist directory.
A more severe diagnosis, of course, results in heavier lifetime cost burdens. A patient with major depression can spend an average of $ 10,836 per year on health care costs. During this time, a person with diabetes who takes insulin can spend $ 48,000 to manage their condition.
Access to care is limited
Access to and coverage of mental health and addiction treatment has improved in recent years thanks to the 2008 Mental Health Parity and Addiction Equity Act, which prohibited health insurers from returning coverage. more restrictive mental health than that of physical ailments. This law and other legal and regulatory updates have helped end the blatant discrimination against behavioral health care.
But there are still many medical and insurance loopholes that prevent patients from getting affordable care, says Angela Kimball, national director of advocacy and public policy at the National Alliance on Mental Illness.
And there are many other factors as well, she says.
Mental health and drug treatment centers and clinics, for example, are usually concentrated in urban areas. Rural areas of the country tend not to have access to more specialized treatment options – similar to the barriers that exist in traditional physical medicine.
In fact, more than 112 million Americans live in areas where mental health care providers are scarce. States like Missouri, Arizona, South Dakota, Montana, and Washington are among those with low rates for meeting residents’ mental health needs. Nationally, research shows that the United States is likely to continue to suffer from a shortage of mental health professionals through 2025.
Many providers still operate outside the health insurance system, so for patients, they are out of the network, which is costly, says Carol Alter, medical director of the system for behavioral health at Baylor Scott and White Health, based. in Dallas.
“Even with the number of psychiatrists and psychologists, there is no one to turn to,” says Alter.
Indeed, only 56% of psychiatrists accept commercial insurance, compared to 90% of other non-psychiatrists. (Insurers pay licensed mental health professionals like psychiatrists lower negotiated rates for their services compared to physicians with similar backgrounds and levels of experience, and they are subjected to more paperwork.) As a result, those seeking mental health care are more than five times more likely to seek care from an off-network mental health professional than for medical or surgical services.
These factors have real consequences, says Alter.
“Often times, mental health disorders are underdiagnosed and certainly undertreated. What usually happens is that most people don’t get treatment for it, or they can get treatment, but not effective treatment, ”she says.
In fact, less than half of Americans with mental disorders receive proper treatment, according to the National Institute on Minority Health and Health Disparities (NIMHD). Alter says that only less than 10% of patients who have a mental health disorder receive effective treatment.
And the numbers only get worse when you look at black Americans – the percentage who can access treatment is only about half that of white Americans, according to NIMHD.
The changing landscape
One way forward is to increase training and collaboration between primary care physicians and mental health professionals, Alter says.
“The point is, most mental health problems show up in primary care – they don’t show up to a mental health professional,” she says. “There are things that can be done to help primary care physicians diagnose and do better. It’s not just doable, it’s actually where primary care goes. “
Another shifting dynamic is the use and expansion of telehealth and teletherapy amid the pandemic, which studies have shown can be effective in treating many mental health issues. Online counseling services like Talkspace and BetterHelp can cost less than traditional in-person therapy with prices ranging from $ 60 to $ 90 per week. And Talkspace is covered by many major insurers, including Cigna, Humana, and Premera Blue Cross Blue Shield.
But part of the recent expansion of teletherapy is based on emergency legislation and guidelines that lifted many existing restrictions, including the ability of mental health professionals to practice across state lines. It remains to be seen whether the waivers will remain in place after the pandemic ends and whether Medicare, Medicaid and commercial insurers will continue to cover these services at the same levels.
Medicare is another area for change, Kimball says. Right now, Medicare offers one of the worst coverage options for people with mental health and addiction issues.
Medicare, for example, has a lifetime limit of 190 days for inpatient psychiatric care. And while that may sound like a lot, it’s sadly insufficient for those diagnosed with serious or chronic mental health issues at a young age.
Additionally, studies show that Medicare does not offer a strong network of mental health professionals, covering only about 23% of psychiatrists in the United States.
Making changes to Medicare could not only improve coverage for plan members, but also spur change across the insurance industry. “As a federal program, it often serves as a baseline that can really get commercial insurers to know what they’re going to do,” Kimball says.
And while Kimball says she is optimistic that legislative and regulatory changes are on the horizon, she is concerned with providing care and treatment to those in need today. For those looking for affordable mental health services, there are a number of organizations that can help.
Kimball’s organization, NAMI, has a hotline that offers free support and advice Monday through Friday, 10 a.m. to 8 p.m. ET. You can reach the helpline at 1-800-950-6264. The organization also offers free, 24/7 crisis text, accessible by texting NAMI at 741-741.
The Substance Abuse and Mental Health Services Administration, which is a government agency, provides a treatment locator to help patients find low-cost treatment facilities across the country.
The National Association of Free and Charitable Clinics and the Nonprofit Open Path Psychotherapy Collective also provide locator tools to help you find mental health services at discounted rates.
If you are a current employee, it is also worth considering whether your company offers mental health benefits through an employee assistance program that can provide services at a reduced or free price.
“People today recognize the need for mental health and addiction care,” Kimball says, but adds that the United States really needs to think about the delivery of health care in this country. “We need private insurers on board and we need to level the playing field so that it’s not just public programs that are holding back all the water. ”
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