One day last fall, I logged onto Facebook to find a long status update from a friend that began “feeling frustrated.” She reported that it took six phone calls and transfers to different offices before she found a new psychologist. She was told things like:
- We’re not accepting new patients at this time
- You’re not in the system
- We don’t take your insurance
- You have to set up a primary care appointment first
Her post lamented that even though her circle of friends was openly talking mental health, the biggest hurdle in mental health care is access to progressive and professional help. Her post concluded, “It’s like you need a psychologist to deal with the stress of finding a psychologist.”
This is the struggle that so many of us face. Nearly 44 million Americans have a mental health condition, but last year, 60 percent did not receive any mental health services. There are many factors at play, but here are four that stand out to me: awareness, stigma, access, and cost.
Awareness
The first issue that prevents people from seeking help is that they simply don’t know what the threshold is for a mental health condition. Many of us suffer from stress or feel anxious, but when those feelings accumulate over time, your well–being can quickly downslide. Being as tuned in to your mental health as you are to your physical health is key to recognizing in yourself when it may make sense to seek some help.
The topic of mental health has been exploding in the media and in public discussions compared to when I first began practicing, but it tends to focus on identifying it. Which leads me to the next issue: Once you’ve identified a mental health issue, what do you do with it?
Stigma
As a psychiatrist, I’ve had patients who would only speak with me on the phone, alone in the privacy of their closest, in the dark because they didn’t want anyone to know they were talking to me. When I considered opening a practice in a rural town in the Midwest, I was told no one would show up because of the stigma of their car being parked outside my office. Stigma, or a fear of how others will perceive you, is a hurdle to mental health care for so many people.
The fact that my friend was even seeking professional help and sharing her experience on social media is not the norm. Those most likely to seek help tend to be women and young adults. Mental health should be just as accessible to the 60-year-old farmer in Wisconsin experiencing symptoms of depression as it is to the 20-something, stressed-out professional woman in NYC. We’ve come a long way, but we still have a lot of work to do to #stopthestigma for everyone, regardless of their gender, age, or background.
Access
Most of us are only asked if we feel anxious or depressed at an annual screening with our primary care physician, which is not nearly enough. It may not be comfortable to discuss with your physician, and there can also be a fear of what happens if you do bring up how you’re feeling.
As my friend’s Facebook post demonstrated, it can be tricky to find help on your own. There’s an extreme shortage of clinicians in the mental health field. More than 115 million Americans live in mental health care health professional shortage areas (HPSAs), where on average, only 26 percent of the need is being met. Even more alarming, more than 60 percent of practicing psychiatrists are over the age of 55, so it may get worse before it gets better.
As a result, it can take weeks or months to see a psychologist or psychiatrist. Imagine having an allergic reaction and being told that you can’t be seen for that long! It doesn’t happen, and it shouldn’t in mental health either.
Cost
Another barrier for many is cost. The top three cost-related reasons for not obtaining treatment are a lack of insurance coverage (payer did not cover at all or did not pay enough), could not afford cost, or no health care coverage.
Lack of insurance coverage is a significant barrier for many: Only 55 percent of psychiatrists accept insurance plans, compared to 89 percent of other providers. The Mental Health Parity and Addiction Equity Act was signed over 10 years ago, but there is still a lot of variation in how insurers interpret how they define medical necessity, separate deductibles and co-pays for mental and medical healthcare.
How do we overcome these barriers?
So now we know the challenges. What is the solution?
In my mind, digital care is the key to breaking through these barriers to mental health care. Care that is easily accessible, no matter where you are, when you need it in that moment. Digital care has tremendous potential to be even better than brick and mortar practices.
We’re already so used to using our phones every day, and they come with us everywhere. I’ve had many patients cancel sessions because of weather, other obligations like work, school, and family (evidence-based treatment requires a one-hour session each week), and stigma.
If people could connect with the right level of care for them from their phone, on their schedule, and from the privacy of their home, we can touch more people, intervene faster, monitor progress more easily, and improve outcomes.
We could help the farmer, the young professional, and anyone in need, virtually. By delivering mental health care on their terms, when they need it, we can help more people feel stronger than they were yesterday.
By Monika Roots
Chief Medical Officer, Sanvello
Dr. Roots practiced as a child, adolescent, and adult psychiatrist. She was also a Clinical Adjunct Assistant Professor at University of Wisconsin-Madison and was most recently the Vice President of Health Services and Behavioral Health for Teladoc Health. In 2016, Teladoc Health acquired her business, CogCubed, a behavioral health analytics company. Dr. Roots earned her MD from University of Sint Eustatius School of Medicine and completed psychiatry residency and fellowship in child/adolescent psychiatry at the University of Minnesota.