The broken mental health system

The mental health system in America is in terrible shape, and unless something is done to fix the problem, it’s going to get a lot worse. School shootings, gunmen in malls, “suicide by cop” and other violent acts continue to dominate the headlines and the news cycle with no end in sight.

The problems are many, with a severe shortage of mental health care professionals and inpatient facilities, combined with the continual decline of insurance reimbursement rates and increasing bureaucratic hurdles leading more than half of psychiatric providers to stop accepting insurance.

This creates an even greater lack of resources — especially for those patients in socioeconomic groups who are not able to pay out of pocket. These patients typically see non-psychiatric physicians, nurse practitioners, physician assistants and other extended-care providers, who handle more than 90 percent of psychiatric care in the United States, yet only receive six to 12 weeks of training in psychiatry over their entire medical school and training careers.

All this leads to misdiagnosis and underdiagnoses of mental health conditions. For example, studies have estimated that only 20 percent of patients with bipolar disorder are correctly diagnosed. In a third of bipolar patients, it takes an average of 10 years to get the correct diagnosis.

The focus for every provider needs to be on diagnostic accuracy, and this will only come by increased training in mental health care within the entire medical establishment. Training through MOOCs (massive open online courses) is becoming more widely accepted as a means of continuing medical education. These online courses give physicians access to the best teachers in the country.

A similar and very simple solution is more online medical education resources that provide timely, unbiased, evidence-based medical education and information from renowned medical experts, researchers and clinicians in the field available on-the-go on all digital devices.

We need to make sure there is more emphasis on the detection and treatment of psychiatric illnesses in the early stages. The sooner a patient receives the correct diagnosis, and the quicker treatment is initiated, the better the outcome. Screening for common psychiatric illnesses like mood and anxiety disorders in primary care practices should be part of the initial differential diagnosis, along with other medical illnesses, rather than an afterthought like it currently is for patients who do not respond to medical treatments or in whom the myriad of unnecessary tests are negative.

Too many patients are bounced around the system until they receive a proper diagnosis. Educating non-psychiatric providers to be extra vigilant in patients who suffer from depression, anxiety or substance abuse, or who have red flags for certain conditions is one such way to ensure a proper diagnosis the first time. These simple messages presented to every clinician can markedly improve diagnostic accuracy.

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We need to reprioritize the payment structure of the new insurance policies. Reimbursement for psychiatric care should be commensurate with higher reimbursements for providing evidence based care. There should be no expectation that dwindling payments will produce better results.

We need to reorganize and strengthen the infrastructure of the mental health field. We need more inpatient psychiatric beds so that the mentally ill are not housed in jails or the streets. The government needs to stop subsidizing organizations and advocacy groups that “help” the mentally ill refuse treatment. The standard for inpatient commitment should be broader than the “imminent danger to self and others” standard. Involuntary outpatient commitment laws like Kendra’s law need to be adopted nationwide.

Mental health is the key to our overall health. As a society, we are more aware than ever that staying mentally fit is just as important as maintaining our physical health. Yet, overall, the mental healthcare field has been neglected, which is unacceptable. The costs involved in maintaining the resources needed to support an adequate system are insignificant when compared to the dividends that will be returned to us in productivity, safety, and a better quality of life.

Dr. Prakash Masand is a former consulting professor of psychiatry and behavioral sciences at Duke University Medical Center and is CEO of Global Medical Education. gmeded.com

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