The Mental Healthcare Conundrum

Scientists announced today that they have discovered a cure for apathy. However, they claim no one has shown the slightest interest in it. — George Carlin

In modern-day America, providing sustainable mental health care continues to be a problem. Some reasons for this include high patient numbers, increasing needs, unpredictable funding, mismanagement, burn-out among employees, and a current model of service that segregates clients by insurance status and income levels. Despite multiple efforts to acknowledge the growing need for universal mental health care and access to appropriate services, a radical disconnect exists between current values in principle and practice. The availability of affordable quality care for those with limited resources is becoming a predominant issue; at the same time there are increasing incidents of mental health illness and an overwhelming demand for treatment services. However, the distribution of funding and the political agendas that drive resource allocation often determine the standards of care while consequentially defining the limitations of social well-being. Despite the Federal Stimulus Package and Health Care Reform Act (combined with selective efforts to increase funding availability in the short-term), the efficacy of mental health treatment and the ability to establish equity in client care remains elusive.

“Continuity of care” is a popular buzz phrase often reiterated in health care management, but in many mental health facilities it appears to be an untenable principle rather than a viable practice. Practitioners who are willing or clinically authorized to provide care are limited and reimbursement for mental health services, from public and private insurers, is decidedly parsimonious when continuous care for an extended period of time is needed. Coordination of treatment services is difficult to prioritize, especially in community mental health environments, because employees are often inundated with surplus caseloads and overwhelmed with the intense level of clinical attention many clients require. To make matters worse, communication between practitioners is subject to time constraints, confidentiality concerns for both clients and clinicians, and the incompatible opinions of various providers (i.e., diagnosis, best practice, etc.). In addition, treatment modalities not subject to empirical restraints have been increasing in popularity.

Ironically, limited funding for those with long-term issues has resulted in the adult and juvenile correctional system becoming America’s largest provider of mental health care. With trends in funding ranging from austerity to punctuated endowments, the future of mental health care is entirely unpredictable. Other issues that continue to emerge appear to be related to operational logistics, biased distribution of public resources, sustainability, and the philosophy of care.

Sociologists have demonstrated that when societies are economically stable, not only do they offer opportunities for mobility, but achieve greater emotional health among its citizens as well. Unfortunately, the anxiety-provoking insecurity of perpetual disenfranchisement creates a revolving door of desperation. However, what evidence can anyone provide for a society to value something when there are dismissive attitudes that ignore the value of evidence? The same protective mechanism of denial employed by some of those with mental illness can also be seen on a larger scale whenever we deny significant social issues. In turn, social attitudes may determine if others will search for help in the first place. For example, a recent study in the journal of Psychological Medicine reinforces the evidence that stigmas associated with mental illness are an obstacle to seeking treatment.1 Shame and fear of humiliation are factors that particularly affect young people, men, minorities, people in the military, and even those working in the health field. If the cultural mindset is that these problems would simply go away if ignored, an epidemic of learned helplessness and disillusionment will certainly follow.

Developing a qualitative life experience for someone suffering from mental illness requires time, adequate resources, attentive care, and patience. If hospital-based treatments, inpatient treatments, and outpatient services have not demonstrated significant clinical improvements for clients, an inevitable restructuring of methodologies will have to be achieved. Trans-institutionalization does not provide a solution for sustainable rehabilitation, and agenda-centered care should not surpass client-centered care. Likewise, reversing the stigma associated with mental illness and encouraging family members and communities to advocate for those who are suffering could positively influence future legislation and shift cultural attitudes regarding the need for comprehensive treatment methods.

Throwing money at a problem doesn’t make it disappear (envision a parent writing large checks to a psychologically damaged teenager). How resources are managed and best implemented should safeguard against the commodification of the client and the exploitation of the care provider in both public and private sectors. Unless mental health care is sufficiently appreciated on a national level, less people will be willing to seek treatment and fewer employees will be willing to provide treatment services. The qualitative must not be reduced to the quantitative, and fostering compassionate intrigue should not be overshadowed by compassion fatigue.

(This article originally appeared in the NPI Newsletter, Summer 2014).

  1. Psychological Medicine / First View Article pp 1–17

What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Published online: February 26, 2014; Copyright © Cambridge University Press 2014