Despite all the progress being made in helping people with mental health issues, for all the years spent improving our understanding, May is Mental Health Awareness Month, after all one of the lingering challenges is that people’s perceptions of treatment of mental health have not evolved far enough from the days of paramedics and straitjackets.
There is tremendous stigma, said Dr. Mark H. Rapaport, CEO of the Huntsman Mental Health Institute. There is a belief that, somehow, diseases of the brain are diseases of one’s character or personality weaknesses when they are real, biological diseases such as heart disease or lung disease or whatever.
Proof of this is the different ways our healthcare system handles mental health problems versus other disorders.
If someone feels physically ill, they will likely make an appointment with their doctor or visit the urgent care clinic aligned with the insurance plan network or, worst case scenario, go to the emergency room. They will be treated for the problem, hospitalized if it is severe enough, and then referred to a specialist.
An insurance provider, if the patient has one, will then pay all or part of the bill, depending on how much is covered by their employer or Medicaid or other means. It’s not a perfect system, but it’s what we have.
When someone has a mental health emergency due to anxiety or depression, for example, the chain of events isn’t quite the same, experts say.
We’ve come a long way in the past few years, particularly in the crisis services area, said Rep. Steve Eliason, R-Sandy, whose day job is senior finance director for University of Utah hospitals and clinics. One positive development in Utah, he said, is the SafeUT app, which students and parents can put on their phones to get instant access to licensed counselors ready to listen anytime at no cost.
Once the emergency is over, things get tough and are very different depending on where people get their insurance.
Those with accepted insurance at University of Utah health care facilities, if they live in Salt Lake City, will likely go to the University of Utah hospital emergency room, Eliason said. Once they do there, if they are treated for a mental health crisis, they will likely be sent to the US-affiliated Huntsman Mental Health Institute for inpatient treatment. But if they’re part of another insurance system, Eliason added, they’ll start out at a hospital that’s networked and, if necessary, go to a smaller psychiatric ward that’s also in a networked hospital.
There are some insurers who are refusing to have a relationship with us now, Rapaport said. Some companies, he said, work very hard to keep their customers in their healthcare system. (Rapaport wouldn’t name names, he hopes he can build bridges with those suppliers.)
Getting a referral for a psychiatrist can be a battle, Eliason said. If you search your network for a psychiatrist, you often find that those doctors aren’t taking on any new patients. And if someone has to go off the grid, the costs go up dramatically.
Some of the difficulty finding psychiatrists, Rapaport said, is that insurers reimburse them at lower rates than doctors who specialize in other fields. It’s just phenomenal, the disparities when it comes to the reimbursement rates made for those services compared to other medical specialties as well, he said she.
Eliason said some psychiatrists and therapists, in Utah and nationwide, have become so fed up with bureaucracy and insurers withholding payment that they have entered private practice in cash only.
The COVID-19 pandemic has exacerbated mental health treatment problems in different ways, Eliason said. Early in the pandemic, hospitals turned psychiatric wards into emergency COVID wards or closed beds due to staffing issues. Now that the pandemic emergency has been declared over, many of those beds have not been returned to their original destination for psychiatric patients [needing in-patient mental health treatment]Eliason said. And those beds were in short supply before the pandemic.
Meanwhile, the pandemic has also increased people’s anxiety levels. There’s probably not an American who hasn’t experienced some sort of mental health problem during the pandemic, Eliason said, whether it’s just a brief burst of anxiety waiting for a COVID test to return, or being locked down , or fear of losing. their work.
The mental health statistics in America are alarming.
The results of a Gallup poll released this month found that depression in the US has reached new highs. About 29% of Americans reported having been told by a doctor or nurse that they had depression at some point in their lives, and 17.8% said they had or were being treated for depression, both those are the highest rates the survey has found since Gallup began asking the questions in 2015
Utah does not fare well in national rankings for mental health care. Among the 50 states and the District of Columbia, Utah ranks 46th from the bottom in the number of adults with higher prevalence of mental illness and lower rates of access to care, according to the nonprofit group Mental Health America. (States bordering Utah, Arizona, Colorado, Idaho, Nevada, and Wyoming all rank in the bottom 10.)
In a similar Mental Health America ranking covering children, Utah does best: 30th in the nation.
In 2021, according to the U.S. Centers for Disease Control, 643 Utah residents died by suicide, a rate of 20.1 for every 100,000 people in the state, placing Utah 14th nationally. The CDC listed suicide as the ninth leading cause of death in Utah that year.
Comparing Utah to other states doesn’t mean much, Rapaport said, in terms of the cost of treating mental health problems.
There is no good place when it comes to equality for mental health treatment in this country, as long as we have a paid model, Rapaport said, as long as we have a model where people are paid less to take care of people. who have brain disease rather than heart disease, diabetes or high blood pressure.
Eliason cited a study by the University of Utah’s Kem C. Gardner Policy Institute that showed how much more difficult it has become to get comprehensive health coverage. Just one data point in the study: In 2007, only 3 percent of health plans sold in Utah were highly deductible, meaning the patient paid more upfront and out of pocket for their care; in 2020, 38% of health plans sold here were highly deductible.
Insurance companies can also be, as they say, wise and stupid.
We are creating a crisis care center so we can have a decent and appropriate place for people with psychiatric disorders to receive treatment, Rapaport said. But we have to go engage and argue with the insurance companies, saying that the reasonable fee for crisis care services is less than what it costs when you send the same patient to the general hospital emergency room.
Inadequate mental health treatment costs money in other ways. Rapaport said anxiety disorders, nationwide, cost the country more than $4 billion a year in lost jobs and wages.
We lose a week a month in productivity, he said.
Eliason said transparency in health care pricing would go a long way in pointing out and perhaps even addressing disparities in insurance payments. He said he is working on a bill to address this issue and may be ready to introduce it during the 2024 Utah Legislature.
Will I get what I pay for’s transparency, in terms of access, is really important, Eliason said. [Patients] they need to be given that information, so they can make the best choice out there.
Transparency could also prompt suppliers to cut costs like a gas station owner who sees the gas station across the street drop their price by a cent, so they have to drop their price by a cent as well. When it comes to health care, those pennies add up.
There is much more that should be done. Hospitals should dedicate more beds and resources. Insurance companies should put mental health providers on an equal footing with other specialists. And both groups need to find ways to make finding treatment less expensive and confusing.
Mental health underpins so many other challenges with homelessness, substance abuse, education, prisons, elder care, treatment of veterans, and more. Solve the challenges in our mental health care and Utah will go a long way towards finding solutions to these problems.
Note to Readers: Paul Huntsman, Chairman of the Board of The Salt Lake Tribunes, is a member of the Huntsman family, which donated $150 million in 2019 to launch the Huntsman Mental Health Institute.
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