Under-Addressed and Overlooked: The Mental Health Issue


When you think of the costliest chronic health conditions, diseases such as cancer, diabetes and heart disease come to mind. However, topping the list is a disease that unfortunately has long had a stigma associated with it—mental disorders.

Now, with more than 40 million adults and 17 million children in America coping with mental health challenges, and more than $200 billion spent annually to address these issues, it’s time to overcome the stigma. Mental and behavioral health needs to be a prominent focus of population health.

While the mental health parity laws passed in 2008 requiring insurance companies to treat mental illness the same way they treat medical conditions, access to care remains an issue. Today, nearly 1 in 5 adults are living with a mental health illness, and many suffering do not receive the treatment they need. According to the Substance Abuse and Mental Health Services Administration, 57% of adults with mental illness do not receive treatment, and among children, 64% with major depression were untreated in 2013.

A number of factors are influencing access to care, but surprisingly one of the most prominent is the dwindling supply of psychiatrists. Between 2003 and 2013, factoring in population growth, there was a 10% drop in the number of practicing psychiatrics in the country. The numbers are even more alarming when it comes to available care for children. More than 15 million young patients need services and yet only 8,300 child psychiatrist specialists practice in the country, according to the American Academy of Child and Adolescent Psychiatry. That’s one psychiatrist for more than 1,800 children.

Given the lack of availability, many patients, both young and adult, resort to the only option: the emergency room. A recent study found that people with mental health conditions rely more on emergency rooms compared to patients who have physical illnesses, and are more likely to be admitted when they show up. Psychiatric patients also are likely to stay much longer. An online survey conducted by the American College of Emergency Physicians exposed the harsh reality for many psychiatric patients—most are forced to wait long hours, even days, for an inpatient psychiatric bed. One quarter of the physician respondents reported that they have had patients waiting up to two to five days for a psychiatric bed.

In addition to fewer specialties to care for these individuals, many contribute the overcapacity and long wait to a decrease in psychiatric inpatient facilities. In the 1960s, there was a large deinstitutionalization of mental healthcare from inpatient to outpatient facilities. As a result, between 1970 and 2006, state and county psychiatric inpatient facilities in the country fell by 87% from about 400,000 beds to fewer than 50,000.

With fewer resources, the country is facing a mental health crisis. As one researcher, Suzanne Lippert, MD, put it, “We have a potential perfect storm. Decreasing psychiatric inpatient beds. Insufficient accessible outpatient psychiatric centers for crisis stabilization, and then increased emergency department crowding. We are really seeing the growing crisis of unmet psychiatric need.”

While much needs to be done to fix the mental health crisis, one major key to improving mental healthcare is to better integrate mental and physical healthcare services.

Intermountain Healthcare conducted a decade-long study to research the impact of delivering integrated mental and physical healthcare using a team-based approach. By integrating care in primary care settings, they found more patients were screened for depression, which enabled them to intervene earlier. They also found utilization was lowered, with a 23% decrease in emergency room visits. To truly deliver population health, more organizations need to follow in Intermountain Healthcare’s direction.

By pursuing innovative models that integrate mental and physical health, we can prevent health conditions from escalating and keep more patients out of the hospital. No longer should mental health be overlooked; it needs to be addressed as focus of population health.

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Topics: healthcare delivery social determinants of health

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