The post ARCHIVE: TOC: December 2001, Volume 10, suppl 1 / Debunking myths around ‘light’ cigarettes and implications for ‘reduced risk’ products appeared first on The Center.
The post ARCHIVE: Health impact of “reduced yield” cigarettes: a critical assessment of the epidemiological evidence [FREE FULL TEXT] appeared first on The Center.
What happens when society decides it will reimburse tens of thousands of dollars (or even hundreds of thousands) for a surgery that may offer only incremental improvements to a person’s health or longevity, but won’t spend thousands to help that person’s mental health?
You get a second-class system of care. In America, we call this the mental health system, which is a separate and completely unequal player in the U.S. healthcare system. In fact, it is so dysfunctional and underfunded that American mental health care resembles some third-world countries.
The Boston Globe continues its examination into the Massachusetts mental health care system. And what they find is hardly surprising.
A lot of people think of Massachusetts as a liberal state, home to world-class renowned, very rich universities such as Harvard and MIT. They believe that because it’s a blue, liberal state with a lot of wealth living within its borders, it must offer some of the best social services in the nation.
However, nothing could be further from the truth.
The sad reality is that Massachusetts continually funds its budget deficits by cutting the barebones social services it does offer, slashing those services to its most vulnerable citizens — those who are poor with serious mental health concerns. While mental health outpatient spending per capita has stagnated over the past decade, spending on inpatient services has been cut in half.
Much-needed inpatient beds have been cut as the state has closed all but two of its public hospitals for those with psychiatric problems. While it did open a state-of-the-art facility during that time — the Worcester Recovery Center and Hospital — the facility only serves a tiny portion of those who need inpatient services. In short, the state apparently doesn’t believe such services are needed much any longer.
Meanwhile, the state’s role overseeing mental health care shrunk steadily, and work once done by state employees, such as tracking down patients who missed appointments, was increasingly left undone. […]
The result, the Legislature’s Mental Health Advisory Committee concluded in 2014, is a system in which accountability for the care of the most severely ill people is often “lost or nonexistent.” They bounce from hospital to hospital, caregiver to caregiver, until, with some frequency, something awful happens.
Still, governors have continued closing psychiatric hospitals. Under Mitt Romney, the state shut down Medfield State Hospital in 2003, and, crucially, shuttered a specialized unit at Taunton State Hospital for men with severe mental illness who were prone to violence but not necessarily criminals.[…]
A few years later, the Patrick administration shut Westborough State Hospital earlier than expected to erase a $13 million hole in the Department of Mental Health budget.
Most Americans carry health insurance now, and it’s been mandated in Massachusetts long before the nation’s Affordable Care Act became law.1 So maybe it’s not so bad in the mental health care market most of us access…
But the underfunding of mental health care also affects people who rely on private insurers for their treatment. One in six mental health clinicians in private practice say they no longer even accept insurance because repayment rates are so low, according to a 2015 study by CliniciansUNITED, a union-affiliated group. […]
One Brookline social worker said she stopped accepting United Behavioral Health insurance because its payment rates were so low that her take-home pay came to well under $35 an hour.
“Rates have remained flat. My cost of living has gone up significantly,” said the social worker, who asked that her name not be used. “It’s embarrassing how poorly we get paid.”
But it’s far worse than that. I hear stories every week about people looking for a new psychiatrist in their community. They’ll call every psychiatrist listed on their insurance company’s directory, and count themselves lucky if they get a single call back within a week. The earliest appointment available? It can vary from 1 to 5 months out. You claim people don’t wait for healthcare in the U.S.? Millions waiting for mental health care will tell you differently.
One of the biggest problems is that apparently we’re not willing to pay mental health professionals what they’re worth. Pay and reimbursement rates for outpatient services has stagnated and barely budged in the past decade for most therapists, psychologists, and, to a lesser extent, psychiatrists.
Meanwhile, physician pay in general healthcare continues to increase year after year. In 2010, a general surgeon earned a median salary of $343,958, according to the Bureau of Labor Statistics. In 2015, that rose to $395,456, a 15 percent increase. Compare that to clinical psychologists, who earned an average of $66,810 in 2010. In 2015, that rose to $70,580 — a meager 4.6 percent increase (which barely keeps pace with the annual inflation rate of 1-2 percent).
In many health plans, rates have actually been cut, driving professionals to stop accepting health insurance from some of the biggest providers. As a career, entering into the mental health field makes less and less sense as a way to make a living that will grow along with your experience.
There are no easy answers to the growing problem of people’s increasing lack of access to mental health care. Things are actually going to get far worse before they get better, since nothing is even in the pipeline for discussion. The latest U.S. Congressional bill to help address the mental health needs of the nation is stagnating in a Senate committee (and didn’t really increase funding for mental health care at the levels needed to make any kind of meaningful difference).
Many states in the country are facing significant problems of opioid overdose among their citizens, resulting in 78 Americans dying every day due to overdoses. Despite this public health crisis, Congress could only muster a bill that encourages people to get treatment but doesn’t actually increase any funding or resources to help combat the crisis. This is what passes for “action” in Washington, D.C.
In short, if you’re an American and don’t want to (or can’t afford to) pay cash to your professional, you’re getting some of the worst care in developed countries for any kind of mental health problem. And that’s unlikely to change anytime soon.
Read the Boston Globe article: Spotlight: The Broken Covenant
Editor’s Note
While I admire and respect the Boston Globe’s venerable Spotlight team for this series of articles highlighting the poor mental health care in Massachusetts, I’m also completely put off by their focus on violence in people with mental illness. Time and time again, they illustrate their argument for needing more mental health care resources in the state by sharing stories of violence. I guess they only motivating factor that might move the needle in the public’s mind is fear. This, despite the overwhelming evidence demonstrating people with mental illness are far more likely to be victims of violence than its perpetrator. It’s a disappointing slant that only goes to reinforce the mistaken prejudice that people with mental illness are prone to violence, allowing people to feel free to discriminate against them.
Footnotes:
I’m generally a positive person. I look for the good in each day, make lemons out of lemonade and try to practice what I preach. When negative feelings take over it can be hard to feel confident. Today I was overwhelmed and really tried to be positive person, but it just wasn’t working. I’d be lying if I said each day was easy or that every time I got knocked down I bounced back without a scrape. However I have learned some great ways to feel more positive even on bad days.
Although I thought today was going to be filled with rainbows, butterflies and all that happy stuff, it just wasn’t. I struggled to get the simple things done. The bully in my brain was beating me up, reminding me of how little progress I was making. By the time I sat down to write this I was the poster child for writers block. I felt insecure. I struggled with grammar, with simple concepts and my creative energy was gone. I researched stuff I already knew, wasting my time with articles on things that don’t even matter. I was deep in the “Google Black Hole” when all the sudden I found something that transformed my mood (for a little while at least). An article I wrote a few years ago that was actually good.
We spend so much energy trying to outdo ourselves, trying to be better than the person we were yesterday that we forget how awesome we are. Many of us spend most of our time worrying about the future or fixating on past failures that we don’t sit with whats real: We are only in control of this one moment. Anything else leads to insecure thinking and low self-esteem.
You’ve done a lot of amazing things in your life, from making the team, to graduating, even getting out of bed this morning can be an accomplishment. However, when your feeling negative you forget about how fabulous you are. This is your reminder to look back and give yourself some credit.
The point of this rant is to learn how to embrace the present you and love the old you. Sure you’ve been around people who’ve hurt you, experienced pain and rejection, but you’ve also endured days that were way worse than today.
I decided that I didn’t want to feel like the positive person who wrote the article, the Emily that was brave and put stuff out into the world that she was proud of.. I said to myself “Emily do something that makes you feel a little better.” So instead of looking at the computer screen for another four hours, I decided to call a friend, and then another friend, and then finally texted a friend who wanted to hang out. I ate lunch outside which was okay, I saw a cute dog and played with it which was fun and I reconnected with my old self for a breif period which was inspiring.
These steps are cumulative; they build a new more confident mindset the more you use them. Practice till you get there and you will see progress. Reassess along the way and see how your confidence and positive energy grows. Trust me, it does work when you embrace the current feelings and work the tips above. Remember you have unique and valuable gifts to bring to the world, learn to embrace them even on the hard days.
Emily is a psychotherapist, she is intensively trained in DBT, she the author of Express Yourself: A Teen Girls Guide to Speaking Up and Being Who You Are. You can visit Emily’s Guidance Girl website. You can also find her on Facebook, Google+ and Twitter.
A new study finds that most Americans with depression get no treatment at all, while more than two-thirds of patients are treated — even though they do not report depressive symptoms or serious psychological distress.
Researchers from Columbia University Medical Center (CUMC) and the University of Pennsylvania discovered that less than one-third of American adults who screened positive for depression received treatment for their symptoms.
The study also found that among those who are treated for depression, less than one-half of those with severe psychological distress are seen by a mental health specialist.
Results of the study appear in JAMA Internal Medicine.
“Greater clinical focus is needed on depression severity to align depression care with each patient’s needs,” said Mark Olfson, M.D., M.P.H., professor of psychiatry at CUMC and senior author of the report.
“These patterns suggest that more needs to be done to ensure that depression care is neither too intensive nor insufficient for each patient. Although screening tools provide only a rough index of depression severity, increasing their use might nevertheless help align depression care with each patient’s needs.”
The researchers analyzed data from a national survey conducted in 2012 and 2013 of more than 46,000 adults which focused on the treatment of depression. They examined a bevy of variables including depressive symptoms, serious psychological distress, and treatment with antidepressants and psychotherapy.
Investigators also reviewed which health care professionals were providing treatment, as well as other variables including age, gender, race, education, marital status, income, and health insurance.
Approximately 8.4 percent of respondents screened positive for depression, and roughly 8 percent of respondents had been treated for depression. Among adults who screened positive for depression, women, whites, privately insured adults, and college-educated individuals were more likely to receive depression treatment.
There were also differences among groups in the treatments received.
Among those with serious psychological distress, for example, four times as many younger adults received psychotherapy and antidepressants than older adults, and twice as many college-educated adults received both treatments than adults with a high school education.
The researchers did find that patients with serious psychological distress were more likely than those with less distress to receive combined treatment. In these patients, they noted, antidepressants combined with psychotherapy tend to work better than antidepressants alone.
“With the increase in antidepressant use over the last several years, it may come as a surprise to learn that widespread challenges persist in accessing depression care,” Olfson said.
“There are also challenges in connecting depressed patients to the appropriate level of care.”
Source: Columbia University
