Over the last few years there has been a lot of hyperbole about the growing mental health crisis from policy makers. When a mass shooting happens, conservative lawmakers blame mental health instead of guns. While progressive lawmakers point to disparities in social determinants (often singling out mental health) as the cause of crimes committed by underrepresented populations. Even with recognition on both sides of the aisle, the behavioral health system still experiences budget cuts resulting in deficiencies in infrastructure and workforce. With these deficits it is no surprise that behavioral health visits have grown by nearly 200% since 2005, dramatically outpacing growth in medical and dental visits (National Association of Community Health Centers [NACHC ], 2016).
Currently the US healthcare system faces two major challenges in the delivery of behavioral health care. First, is capacity. Nearly all US counties have unmet needs regarding specialty behavioral health services. The second challenge is equity. There is a large inequitable geographic distribution of behavioral health providers in the US. Rural areas and communities with largely minority populations are strongly linked with the lack of behavioral health providers and lack of access to behavioral health care (Fortney et al., 2015). The disparities in the availability of well-trained behavioral health professionals nationally is especially apparent with psychiatric providers. In recent years, the US has seen a 14% decline in graduates from psychiatry programs and nearly half of psychiatric providers are over fifty-five years old (Mechanic, 2014).
According to a recent report by the CDC on behavioral health issues during the COVID-19 pandemic, increased levels of adverse behavioral health conditions were reported by adults in the United States in June 2020. The study found that the frequency of symptoms of anxiety disorders was nearly three times those reported in the second quarter of 2019 and occurrence of depressive symptoms was almost four times those reported in the second quarter of 2019. The study also states that roughly one in 10 of those surveyed reported that they started or increased substance use due to COVID-19. The most alarming finding of the study is that nearly twice as many respondents reported serious consideration of suicide in the past 30 days than did adults in the US in 2018. In June of 2020 as many American adults have seriously contemplated suicide as there are Americans with diabetes (Czeisler et al., 2020).
With systems already stretched beyond capacity and the ongoing effects of the COVID-19 pandemic, the US behavioral health system is at a tipping point. As a behavioral health provider, I am personally experiencing the effects of behavioral health system that was ill equipped prior to COVID-19, that is now imploding under the pressure from the dramatic increase in patient acuity since the beginning of the pandemic. In the 2019 film The Joker Joaquin Phoenix states "Is it just me or is it getting crazier out there?" Amid a global pandemic, economic recession, and political uncertainty that quote feels more relevant each passing day.
How do we fix a behavioral health system that seems broken beyond repair? I hope to answer this question in an upcoming series of articles that break down specific elements of the US behavioral health system and offer solutions to address existing disparities.
Bauer, A. M., Hodsdon, S., Bechtel, J. M., & Fortney, J. C. (2018). Applying the principles for digital development: Case study of a smartphone app to support collaborative care for rural patients with posttraumatic stress disorder or bipolar disorder. Journal of Medical Internet Research, 20(6), e10048.Link
Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. (2020). Mental health, substance use, and suicidal ideation during the covid-19 pandemic — united states, june 24=30, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(32), 1049-1057. Link
Mechanic, D. (2014). More people than ever before are receiving behavioral health care in the united states, but gaps and challenges remain. Health Affairs, 33(8), 1416-1424. Link