Around 50 million, or one in five Americans, are wrestling with their mental health in 2022, according to Mental Health America.
These numbers parallel a recent study conducted by the National Center of Health Statistics in conjunction with the U.S. Census Bureau who partnered on the Household Pulse Survey conducted from Aug. 19, 2020, until April 11, 2022.
The survey revealed that more and more Americans are taking prescription medication for mental health.
By April 2022, 23% of respondents acknowledged that they had taken medication for mental health reasons over the last four weeks. This is up from 19.4% in August 2020 and up from 15.8% prior to the pandemic in 2019.
While there has been little comprehensive study of the pandemic’s effect upon mental health, the rise in statistics is understandable.
According to the COVID States Project, four out of 10 American adults know at least one person who died due to COVID-19.
The one million American deaths from COVID-19 explains why 27% of adults are struggling with moderate to severe depression. Depression is hitting young adults age 18-24 at a staggering rate of almost 50%.
As pandemic restrictions continue to be removed and the infection rates drop, these numbers will continue to rise as the long-term effects of the pandemic become apparent.
Following the 1918 flu pandemic, hospitals and mental health facilities saw a four-fold increase in new mental health patients. In addition, physicians saw dramatic increases in depression and psychosomatic symptoms.
This parallels what we saw in the early days of the COVID-19 pandemic with the rise of anxiety, depression and substance abuse.
Therefore, we should prepare for the impact of these future cases now. Unfortunately, we are already behind due to insufficient hospital beds, therapists and funding.
While the White House’s March 1, 2022, announcement that President Biden is calling for over $1 billion dollars in additional mental health funding is commendable, it is nowhere near enough.
Due to low Medicare and Medicaid reimbursement rates, 26% of psychologists have left the program, moving to private insurance or private pay.
Private pay is not an option for most patients suffering from mental illness, as therapy typically involves multiple sessions at $100-250 each. The amount adds up quickly, especially if prescription drug costs are added on top.
Under the Patient Protection and Affordable Care Act, all non-grandfathered insurance policies are required to provide mental health services. While the ACA has been helpful in paying for services, access is still a problem. Just like Medicare, many therapists have opted out of private insurance due to reimbursement and excess insurance red-tape.
In addition, patients have trouble determining who is in their insurer’s network. While all insurance carriers have a list of in-network therapists and psychiatrists, those lists are woefully lacking and inaccurate.
A 2015 study of 360 psychiatrists in three major metropolitan cities revealed that getting an appointment was difficult. About a third of offices answered on the first call and, of the 216 unanswered calls, only 78 messages requesting an appointment were returned.
This ultimately resulted in 93 appointments out of the 360 psychiatrists – or 26%. In some cases, the physicians were not available. Some were listed inaccurately as in-network or had retired.
A similar study was done comparing pediatrician and psychiatrist availability in 2017, attempting to get appointments for a 12-year-old child by calling 601 pediatricians and 312 psychiatrists.
They successfully gained appointments for 40% of the pediatricians but only 17% of the psychiatrists. On average psychiatric appointments had a 30-day longer wait time. In short, it is too difficult to get an appointment, especially if the patient is in crisis.
While both studies are dated at this point, the increased number of people reporting mental health challenges without a corresponding increase in mental health providers suggests that the situation has only worsened.
In addition to the problem of being accepted by a psychiatrist, patients are wrestling with the inaccuracies of insurance companies in-network provider lists.
Frequently, customers will review the list of network providers and assume their coverage is robust when there are, in actuality, only a few providers who are in-network. It is difficult for insurers to keep up with who has left the network, who is and is not taking patients, and what the current contact information is for a specific practice.
The scope of inaccuracies is illustrated in the recent announcement that the city of San Diego plans to sue three large California insurance companies over inaccurate in-network provider lists, claiming 2019 inaccuracy rates ranging from 29% to 53% for in-network psychiatrists.
While the insurance companies deny these inaccuracies and any wrongdoing, the announcement illustrates the public’s frustration.
The result of these inaccuracies is that mental health patients are filled with additional anxiety as they pointlessly call to try to book an appointment with physicians who are not taking new patients or not in network.
The frustration is more than enough to cause the patient to give up and not get the care they desperately need – or worse, land in a hospital emergency room.
We know that Medicare and Medicaid, as well as private insurance, have failed to make mental health services more available and affordable. As we move into this post-COVID-19 era, we also know that the need for services will skyrocket.
It is time for the Centers for Medicare and Medicaid Services and private insurance – who both hold the public’s welfare in trust – to do better. It is time for those in need to be able to access desperately needed mental health serves without jumping through multiple “hoops.”
Instead of creating obstacles, providers should be actively assisting these patients. This is a matter of justice and respect for human dignity.
Editor’s note: This article is the first in a series this week calling attention to May as Mental Health Awareness Month.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
