By David Joel Miller.
Why is it so hard for mentally ill and the addicted to get treatment?
Worldwide there is a growing awareness that untreated illness is one of the major problems of our time. There are demonstrable connections between our other major issues and mental illness. Wars and violence are an everyday staple in the news. The trauma and the impact of Post-traumatic Stress Disorder get scant mention and are easily forgotten. Global environmental problems affect physical and mental health.
The heaviest users of physical health services, that 5 percent of the population on which we spend fifty percent of our health budget. The majority of them have either a mental health issue, or a substance use disorder. More productivity, measured in days of work missed, is lost due to depression than most of the serious illnesses combined. Why then is it so difficult for those who need treatment for a mental or behavioral disorder to get treatment?
The majority of the mentally ill do not get treatment.
Fifty-five percent of the mentally ill receive no treatment. The statistics for those with a substance use disorder is even worse. Since 2013 the rate of treatment has risen, slightly. But the continuing reality is that majority of mentally ill people do not get treatment.
Every time there is a high-profile violent event, the news asks if that person has a history of mental illness. Even when they have been identified as a mentally ill person the odds are less than fifty-fifty that they were able to access treatment.
People who voluntarily come in for treatment most of the time are those who have depression and they realize they need help. If they are planning on killing themselves or others they may get easier accesses to the mental health system. If their symptoms are less severe they may be told they are not seriously enough mentally ill to get treated just now. Wait till you begin feeling like killing someone and then call again.
Cost, capacity and cognitions are keeping people out of treatment.
The cost of treatment has been a major barrier to getting mental health up till now. The expansion of health care availability has given a few more people access to behavioral health treatment. Even when someone realizes that they need help their fears about the cost may keep them out of treatment. It is not just direct costs, doctor fees, medications the price of counseling, which are a problem. Some people have copays. There is also travel costs and problems in eating away from home.
The parity provisions in the current law were intended to make sure that behavioral health benefits were just as available as physical health ones. Accessing behavioral health services continue to be a challenge for both client and providers.
Recent surveys tell us that we have at best half the number of therapists that are needed to see the number of people who need services. The result of this imbalance between supply and demand is that there are longer waits for services and people who really do need help may get turned away.
Mental illness gets in the way of getting treated.
People with anxiety get nervous around others. They cope by avoiding people. In treatment they are often too scared to wait in crowded lobbies. They miss appointments and then get dropped for noncompliance. Distance or telemedicine is one possible solution but there are still issues about who can do this and when or if insurance will pay if you just talk with this client by phone or internet.
A symptom of depression is loss of motivation. Severely depressed people do not have the energy to show up some days. Being symptomatic can get you turned away from treatment.
Drug and alcohol issues get almost no treatment.
Less than 12 percent of those with substance use disorders are getting treatment. Those who do are most frequently referred, mandated, to treatment by the courts or criminal justice system. The days of 28 day inpatient rehabs are largely gone, most insurers want the person using substances to stay in the place where they formerly used substance and try to get clean there.
Most drug and alcohol treatment is done in outpatient treatment settings. Despite parity laws it has been increasingly difficult to get insurance to pay for treatment. While we are making some progress at getting a few more of the mentally ill into treatment the percentages of those with a substance use disorder has not changed significantly in recent years.
Among those who really need treatment but don’t get it, a major barrier to treatment is the addict/alcoholics own thinking. Most would like to find a way to continue using or drinking and still not be addicted or an alcoholic. Admitting you have an illness, especially the one called addiction is a hard notion for most people to swallow.
More info on the low treatment rates of behavioral health problems can be found at the SAMHSA website.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books