BEHAVIORAL HEALTH
Accessing Mental Health Care Reasons people don’t seek help BY TODD ARCHBOLD, LSW, MBA
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tudies consistently show nearly one out of five people will experience diagnosable symptoms of a mental illness in their lifetime, and less than half of them will ever seek the treatment they need.
According to polls from organizations like the American Psychiatric Association (APA) and National Alliance on Mental Illness (NAMI), a majority of adults reported increased symptoms of anxiety and depression throughout the pandemic, adversely impacting their daily lives. Parents are now reporting more worry and anxiety related to their children’s health. The necessary safety restrictions, such as social distancing, have exacerbated social stressors including financial distress, job instability and food insecurity. These subsequent stressors have disproportionately impacted our BIPOC communities. More people are feeling isolated and disconnected as mental health providers are overwhelmed with referrals. With mental illnesses so prevalent, why don’t more people get help? Nearly one in 13 people suffer from asthma and nearly one in 10 from diabetes; almost all get care or help managing their symptoms. Nearly one
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OCTOBER 2021 MINNESOTA PHYSICIAN
in 10 people suffer from depression, and more alarmingly, nearly one in five adults suffer from some form of anxiety, yet less than half will get professional care. At least half of all cases of mental illness onset before age 14, meaning many people struggle with symptoms from a very early age. Comparatively speaking, most people will never experience the breathing difficulties associated with asthma or the tingling hands and feet that diabetes may cause. Yet everyone knows what it is like to feel depressed and anxious. It is when these feelings begin to impact our daily functioning that we need to get professional help. An acquaintance recently shared with me that she wanted to get involved in mental health advocacy, but had a hard time relating since she did not know anyone with a mental illness. I simply told her, “Yes, you do actually know several people with a mental illness; you may just not know they have an illness.” Many people may be effectively managing their symptoms, but sadly, many are not getting any help at all and are not talking about it. There are three main reasons people don’t get the mental health care they need, when they need it.
Access Barriers These are real, often tangible barriers that prevent someone from getting help. They can range from such things as financial barriers, lack of reliable transportation, geographical isolation, poor internet and more. Some of these barriers can be more easily overcome than others, but in general they only add to functional impairment and create more frustration. Some access barriers may simply be not knowing who to call or where to go. Sadly, many individuals access care only through a crisis with an emergency room as their entry point. Across the nation, we estimate that there is one mental health professional for every 378 people. This includes psychiatrists, psychologists, psychotherapists, advance practice nurses and drug and alcohol counselors. Of course, many of these are specialists and not trained to treat all conditions. Some specialties may focus on treating certain age range or certain conditions, while some are focused on research and may not care for patients directly. On average, psychotherapists carry caseloads of 40 to 60 patients, while psychiatrists carry caseloads closer to 400 and even upwards of 1,000 patients. Minnesota ranks in the middle of the nation, with an average of one mental health professional for every 365 people. Minnesota also ranks above the national average in alcohol and drug abuse, as well as racial inequities. Furthermore, our state has comparatively vast rural areas endearingly referred to as greater Minnesota. In these rural areas, the ratio of mental health providers to the population is close to one for every 1,500 people. Many people in these regions will struggle to find the right mental health provider, if any at all. While telehealth services have been extremely successful in many places, it requires reliable internet and tech-savvy patients. Unlike other health care providers, mental health providers are more likely to be out-of-network with insurance plans as a result of poor reimbursement rates. Many people report being underinsured, so the costs of care become a barrier. It is estimated that nearly one of four psychotherapists do not accept insurance plans, and even fewer psychiatrists are in-network. Paying
