SAN FRANCISCO — Poor access to mental health services is fueling overdose and suicide epidemics in the United States, according to APA president-elect Bruce J. Schwartz, MD.
In an interview with Healio Psychiatry, Schwartz said 70,000 Americans died of overdoses in 2017 and, in terms of suicide, the US is one of the only countries in the world whose rate is increasing.
“I view these epidemics as the effect of the fact that people have a very hard time accessing treatment,” Schwartz said. “If you have depression or an addiction, it isn’t going to be easy to get care and there are many reasons why access is so problematic.”
Among them is the fact that insurance companies have phantom networks and lack panels that are accepting patients, which creates a barrier to care for employees who get their insurance through managed care companies. What’s more, psychiatrists opt out of participating with some of these insurance companies because they underpay in comparison to internists, pediatricians and family physicians.
Schwartz also cited a psychiatrist shortage as a factor contributing to the access issue. Conservative estimates, he said, put the shortage at 15,000 over the next 10 years, especially as the baby boomer generation retires. To help combat this problem and grow the workforce, Schwartz said money for graduate medical education should be increased.
“I believe it’s our moral and ethical responsibility to do everything we can to try and improve access to mental health care,” Schwartz said. “And there are some creative things we can do in terms of using technology, and in terms of integrated care and collaborative care models in primary care settings.”
He also stressed the importance of making more effective use of mid-level providers in the continuum of care and identified problems at the facility level.
“In this country, you can say we have enough psychiatric beds if you count all the beds in jails and prisons, and all the people who have a bed under an underpass in our cities, but we have criminalized the mentally ill and they’ve ended up in jails and prisons,” he said. “It’s estimated that anywhere between 50% and 60% of these people have either a substance use disorder and/or mental illness, and they end up incarcerated in large part, I think, also because of the problems they have accessing treatment.”
The bottom line, he continued, is that the whole medical system is underfunded. “There’s not an area of mental health that you can look at and say, ‘there are adequate resources being dedicated here.’ ... I think policymakers must make a decision; we have all of these crises, many of which are derived from mental health issues, and it’s getting the attention of policymakers as well as politicians because it is very much a bipartisan issue.”
When asked what needs to change in the field of psychiatry in the next 5 years to improve access to care, Schwartz said funding formulas need an overhaul, and the government needs to prioritize the development of new resources, which will require money to be moved around the system.
“That’s why, in a certain sense, the APA has to be the one to make these arguments,” he said. “People are receptive to the arguments and it’s the people in policy positions in the government and governmental agencies who really have to then implement [them] and say as a public priority ‘We’re going to move some of that money from this to that.’”
It happens frequently, he said, but the money isn’t being moved fast enough. “Enforcement of parity doesn’t cost the government any money. If the government really started telling the insurance companies, whether state or federal, ‘You have this benefit, you have to pay for care and make sure it’s equitable,’ more money would be put into the system.”
Lastly, Schwartz touched on recent school shootings, like the one at STEM School Highland Ranch in Colorado, as a problem caused, in part, by poor access to mental health care.
“Most of these shooters are disturbed individuals,” he said. “... These kids have red flags all over them, and in some instances the police have been warned about an individual. It’s the difficulty getting treatment for these individuals that kind of contributes to this problem. I’m all for gun control, but there are so many guns in this country that even if we had full gun control tomorrow, there are more guns than people in this country. But one thing we can do is begin to have more mental health services available.” – by Stacey L. Adams
Disclosures: Schwartz reports no relevant financial disclosures.