Strategic Projective Initiative: Mental Health Crisis
Abstract
Given the recent rise in mental health issue across the United States as a result of the covid-19 pandemic and from the opioid crisis the country faces, this report analysis the key issues related to proper provision of mental health services in the country. The goals of the report include increasing access to mental health to underserved groups, increase the quality of service and a general increase in access to mental healthcare. The key issues identified by this report include funding healthcare mental healthcare treatment, mental health stigma, inadequate psychiatric bed space, and inadequacy of mental health professionals. The latest mental health data reveal an increase in mental health problems among youths and adults. In consideration of all these the report recommended the use of telemedicine to increase accessibility and navigate around the stigma surrounding individuals with mental health problems. Other recommended solutions include restructuring professional culture and changing the funding system used in the country’s healthcare framework.
Contents
Inadequate public psychiatric bed. 4
Funding issues attached to mental healthcare. 6
Inadequacy of mental health professionals. 6
Use of Telemedicine in delivering healthcare. 10
Restructuring professional culture. 11
Changing the funding system in the country’s healthcare system.. 11
Benchmarks for success and contingency plans. 13
Introduction
Mental health is a constant problem among several individuals within the United States. Regardless of age, there are several factors that influence the prevalence of mental health challenges among different individuals. Adults (those above 18 years) have several factors that expose them to mental health risks. These include profession and social issues. The profession includes different job-related factors that expose individuals to mental health. They may include job deadlines, extended scope of duties and responsibilities as well as the culture within a specific profession. The element of professional culture can be seen from the military culture (Paice, 2019). Military personnel are expected to experience any mental health problems as that can be viewed as a weakness of an individual. Similarly, adults also experience several mental health challenges from their social environment as a result of stigma from the community and abusive relationships from their partners. The prospect of navigation through tough economic times characterized by increased interest rates and high inflation also results in a mental challenge among adults.
Studies have identified that almost half of adults experience mental illness during their lifetime. On the same note, 5% of adults, which is equivalent to 43.6 million people also experience mental illness on an annual basis. Goldman, Druss, Horvitz-Lennon, Norquist, Kroeger Ptakowski, Brinkley & Swartz (2020), observed that 14.4% of older adults have one mental disorder, while 5.8% have two disorders and 6% have three or more mental disorder. Out of all these, only 41% of individuals with mental health problems receive mental treatment. Similarly, half of the mental disorder cases begin at the age of 14 years and three-quarters by the age of 24 years. This also presents the importance of the youth population in mental health issues. Specifically, adolescence forms the stage in which the majority of youths (individuals aged between 12-17 years) start to experience different mental health issues like anxiety, depression, and substance abuse. In consideration of these, the report is set to analyze different mental health issues faced by the American population together with the mental health environment within the country’s healthcare sector and provide viable recommendations that can be used in containing mental health problems within the united states’ healthcare sector.
Key issues
There are several issues surrounding mental health among the American populations. Some of the key issues in this regard include mental health stigma, inadequate psychiatric bed space, the inadequacy of mental health professionals, and healthcare funding problems (Paice, 2019).
Inadequate public psychiatric bed
Psychiatric hospitalization is the best treatment method for individuals with acute chronic and mental conditions. Individuals with no insurance coverage, those charged with a crime, and are violent and dangerous to themselves and the general public are always treated in publicly supported state psychiatric beds. The psychiatric bed space among medical centers across different states including both public and private medical centers have significantly reduced over the years. Currently, the United States is ranked position 29 among the 34 states that constitute the organization for economic co-operations and development with a psychiatric bed capacity of 11 beds per 100,000 people (Cadigan, Lee & Larimer, 2019).
While the majority of individuals with acute mental health wait for bed space to open up among medical centers the police and firefighters are always diverted to mental health calls. This results in inappropriate utilization of the available scarce resources within the community, consequently, while the police are busy responding to these diversions, crimes like violent robbery and other crimes emerge within the community (Currier, McDermott & McCormick, 2017). Moreover, considering that the majority of individuals with acute medical conditions cannot take care of themselves and make a proper ethical judgment, they present a danger to themselves and the society. This explains why the country has been experiencing increased homicide cases including suicide. Through all these the inadequacy of psychiatric bed space among healthcare facilities in the United States presents more danger to the society. There is a need to deal with the issue of availing psychiatric beds among healthcare facilities.
Mental health stigma
The general perception that exists among the American population is that individuals with mental illness issues are dangerous to themselves and to the general community. Through this, in most cases, the majority of community members distance themselves from individuals with mental illness. As a result of such communal perception, individuals who experience mental illness issues always try to suppress such conditions with the use of several substances like cocaine and marijuana (Paice, 2019). In the long run, these individuals become addicted to these substances. The addiction further exposes them to more mental health illnesses, which reduces their value and worth in the community.
On the same note, there exists a perception that individuals experiencing mental illness are generally weak and incapable of performing several duties in the society (Corrigan & Nieweglowski, 2018). Individuals with mental illness challenges are always denied employment opportunities hence they have to fend for themselves using any necessary mechanism available to them including robbery and forgery, which increases crime within the community. Some cultures among different professions like the military always view individuals facing mental health problems to be weak and cannot navigate through the turbulent war life. Through this, the majority of military personnel with mental health issues cannot openly present their problem and try to deal with such conditions in their own manner (Cadigan, Lee & Larimer, 2019). In consideration of all these the stigma related to mental health is a real issue in the society that should be dealt with amicably.
Funding issues attached to mental healthcare
Healthcare funding has also presented a significant challenge to the level of accessibility of mental healthcare services and the quality of such health services. The first issue, in this case, relates to the out-of-pocket payment system that is largely used in accessing mental healthcare services across the country. Through this, the majority of individuals with mental health problems and with no insurance coverage always suffer mental health problems and chose other mechanisms like the use of substances to manage such conditions (Reardon, Harvey, Baranowska, O’Brien, Smith & Creswell, 2017). On the same note, considering that the majority of average Americans’ income levels can only allow them to satisfy the basic needs of shelter, food, and clothing, the majority of them do not consider purchasing insurance covers. The few individuals who manage to access these covers only purchase covers for serious health conditions ignoring their mental health. On the other hand, several states have significantly reduced the funding provided for mental health services over the years, which further presents the challenge of poor mental service delivery as a result of inadequate resources. Through all these, there is a need to ensure proper funding of mental health across the country.
Inadequacy of mental health professionals
The United States is experiencing a significant inadequacy of mental health professionals, which further impacts the effectiveness of different mental health programs in the country. Narendorf (2017), observed that more than two-thirds of primary care physicians cannot find a mental healthcare professional after they have completed the diagnosis process. The available few mental health professionals are over-utilized, something that results in poor quality mental health care. This further contributes to increased morbidity and mortality rates within the country. There is a need to increase the number of mental health professionals within the country so as to enhance the quality of mental health services.
Situational analysis
Mental health has been a constant health issue across different nations. Though different states in the US have in place different measures channeled to ensure proper mental health among their populations, still the prevalence of mental health is relatively high within the country. The state of Nevada leads in consideration of adults with any mental illness (AMI) and poor accessibility of mental health facilities. It is followed by Oregon and Idaho states. Pennsylvania, New York, and Vermont are the three states with better accessibility of mental healthcare and a low rate of mental illness among adults (Goldman et al., 2020). In relation to youth mental health (individuals aged between 12-17 years) the district of Colombia has the lowest number of youths with one major depressive episode (MDE) in the last one year with a total of 3,000 youths (Goldman et al., 2020). It is followed by Louisiana and New Jersey states with a total of 39,000 and 77,000 respectively. Oregon and Idaho states are the states with the poorest record in relation to one major depressive episode among youths with 16.34% and 16.22% of their youth’s population experiencing the same (Goldman et al., 2020). Through all these, a total of 2.2 million youths across the United States are exposed to severe major depression. The number represents an increase of 121,000 cases from the dataset provided in 2019 (Goldman et al., 2020). Similarly, the majority of youths experiencing this condition are also exposed to other unethical behaviors in the society like substance abuse, disorderly behaviors, and anxiety. The states of Mississippi and North Dakota have the lowest prevalence of youths with server MDE a prevalence of 6% while the states of Nevada and Maine have the highest prevalence rate of 13.2% and 13.1% respectively (Mental health America, 2020).
There is also an evident struggle in the accessibility of mental health services among American youths. Mental health America (2020), identified that a total of 59% of youths with MDE haven’t received any mental health treatment. Similarly, close to 50% of youths do not receive mental health services that they need. Rhode Island has the lowest prevalence of untreated youths suffering from depression with a rate of 39.5% followed by Connecticut with 43.9% (Mental health America, 2020). Both North Carolina and South Carolina states have the highest prevalence of untreated youths suffering from depression with over 74% of the youths suffering from these ill-health conditions fail to get treatment. Other states with over 70% prevalence rate include Nebraska, Georgia, and Kansas with 71.3%, 70.9%, and 70.8% respectively (Mental health America, 2020). A total of 73% of youths have been identified to have emotional disturbance (ED). Emotional disturbance has been identified as the primary factor that results in social isolation, unemployment, poor academic performance, and involvement in the juvenile system.
Though the Mental Health Parity and Addiction Equity Law (MHPAE) was enacted to ensure equal coverage of mental and substance use services, the number of youths with private insurance coverage that does not cover emotional and mental problems have been increasing as a result of strict regulations and measures placed by private insurance companies in relation to mental health treatment. The new hemisphere state has the highest mental health coverage among the youths with only 2% of its youths lacking mental health insurance coverage. It is followed by Massachusetts and Vermont with 3.6% and 4% respectively (Cadigan, Lee & Larimer, 2019). Mississippi, Louisiana, Nevada has the lowest coverage rate with 18.1%, 16.5%, and 16% of their youths lacking mental health insurance coverage respectively (Cadigan, Lee & Larimer, 2019).
Additionally, the Community Healthcare Act also empowered the de-institutionalization movement, which has resulted in a significant reduction of psychiatric beds of up to 95% of the total mental health bed space. States have also been reducing their budget in relation to mental health provision. Between 2009 and 2012 states cumulatively cut $4.3 billion from mental health budget (Cadigan, Lee & Larimer, 2019). These also show the level of reluctance that exists among different states across the country in relation to dealing with mental health issues. There are some other state restrictions like in the case of Virginia in which the civil commitment law demand physicians who want to admit psychiatric patients to draft a treatment plan within four hours and seek approval of a magistrate before finding a psychiatric bed (Cummings, Allen, Clennon, Ji & Druss, 2017). The impact of this can be seen in senator deed’s son who was released due to lack of psychiatric bed space. The young deed went home and stabbed his father before killing himself.
Strategy formulation
Formulation of viable strategies that can help in addressing the different issues surrounding mental healthcare in the US to ensure quality mental health among the country’s population requires consideration of all the elements involved (Chow, 2016). These include the identified mental health issue, the different stakeholders involved together with the available systems and procedures within the country’s healthcare system as well as the social environment within the country. The different strategies formulated by this report considered the mental health issues identify as well as the different stakeholders involved. The strategies also incorporated the country’s mission of achieving universal healthcare among its population and the goal of being the leading healthcare providing nation across the globe.
Recommendations
Use of Telemedicine in delivering healthcare
The constant technological innovations and inventions witnessed in the contemporary world have resulted in different systems and procedures that medical centers need to incorporate to enhance the quality of their services. Telehealth and telemedicine technologies are specifically designed to allow medical centers to provide healthcare services to individual patients in the comfort of their homes. Telemedicine entails the use of telecommunication technology and information technology in providing remote clinical services to patients (Cummings et al., 2017). The use of these technologies will ensure the challenge of stigma surrounding individuals experiencing mental health disorders are effectively contained since it promotes privacy. The telehealth services are also relatively cheap compared to the traditional face to face treatment regime. This increases mental healthcare accessibility even to the average Americans with difficulties in accessing mental health services as a result of a lack of finances can access.
The different technologies used in implementing telehealth services are compatible with the technologies owned by a majority of the country’s population. Some of these technologies include virtual appointment technologies like video conferencing devices, remote monitoring technologies including interactive voice response technology and personal health records like mobile phone applications (Ospina-Pinillos, Davenport, Ricci, Milton, Scott & Hickie, 2018). There are several other technologies that can also be supported with the well-furnished technological infrastructure in the country. These can include narrow-band technology and internet-based technologies.
Restructuring professional culture
There is also the need to restructure the existing professional cultures across the country to help in fighting the stigma surrounding individuals with mental health problems. The social culture of stigmatization of individuals with mental health issues can only be addressed by the culture among different professions. First, these individuals need to be assimilated into the workforce environment by embracing workforce diversity, which requires a change in the existing culture among different professions. Secondly, some professions like the military need to change their culture of prejudice against individuals with mental health problems and create an environment that can allow such individuals to seek mental health treatment.
Changing the funding system in the country’s healthcare system
The funding system with the United States’ healthcare framework has been identified as a constant issue that hinders the majority of average Americans from accessing healthcare services including mental healthcare. The system upholds a two-tier contribution involving the private sector and the public. The public sector contributes through the Medicare and Medicaid programs while the private sector contributes through the out of pocket payment system and insurance programs (Ospina-Pinillos et al., 2018). Though the public sector contribution is available it only serves a small number of the country’s population while the significant majority of the country’s population is using the private contribution framework. Considering that the majority of average Americans cannot afford to contribute through the private sector contribution mechanism available to them, there is the need for re-adjusting the funding system in the country to be fully carried out by the government.
Implementation strategy
The implementation of telehealth services in the country requires the participation of both the patients and healthcare providers in the country. The program should be initiated by healthcare providers in which there is the need for conducting public education in regards to how to acquire different technologies needed for effective implementation of the program and its importance. The public education process should be swift and efficient through the use of various social media platforms like Youtube, Instagram, Facebook, and Twitter. The majority of American populations are active users of these platforms which will ensure the effectiveness of the education program through extensive coverage of the targeted individuals. Respective hospitals are to incur the cost of acquiring different technologies used in telemedicine as part of their capital projects, which will not involve a considerable amount of capital just around $ 100,000 for each facility. This will also incorporate the training cost these medical centers are to incur.
In regards to restructuring professional cultures, there is a need for legislating viable policies that can suppress the stigma the society has against the individuals experiencing mental health issues. For instance, the limitations placed by individual companies in regards to individuals with different mental health conditions can be changed through legislative policies involving that offer incentive to firms who accommodate individuals with such challenges. This will ensure such organizations provide a conducive environment that favors optimal incorporation of these individuals; hence eliminate the stigma surrounding those will mental health issues (Ospina-Pinillos et al., 2018). There is also the need for proper institutional framework among professions like the military that allow individuals to seek mental healthcare without facing prejudice and unfair treatment. This can be further achieved by drafting laws that protect personal interest among individual military personnel. Even if it means an annual mental test conducted among them and upon return from every military assignment. This will ensure timely identification of mental health issues among the military personnel providing room for devising effective intervention techniques before such issues develop into serious mental health problems.
Benchmarks for success and contingency plans
Generally, the success of these solutions will be measured with the prevalence of mental health among different sections of the country’s population like youths and adults. Given that mental health is a perpetual problem resulting from the existing factors in the community like genetic factors, economic factors, and other underlying health conditions like chronic diseases. The effectiveness of these solutions will be measured by the ease of accessing mental healthcare as well as the quality of mental health services, which will be measured by the prevalence of mental health issues among the country’s population especially the average American populations struggling to meet the basic needs.
The number of reported mental health issues among military personnel will also illustrate the effectiveness of these solutions. The number should be increasing on an annual basis as individuals gradually ignore the stigma surrounding mental health among the military profession. The increased mental health service quality will also signal the adequacy of mental health professionals in the community. Similarly, a reduction in crime rates in the community will also inform the success of these solutions.
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