The Reason Mental Health Care Is So Bad In The U.S. & The Doctors Changing That
How to find care that treats mental and physical health equally
by Cassandra Wertz, MD
Internal Medicine
It’s more common than you think.
It’s more common than you think.
It might be somebody coming in for the first time with symptoms of a mental health illness. It might be somebody who already has a diagnosis, and we’re just continuing with whatever treatment plan they have.
Maybe they’re doing so well that they want to titrate off medicines they were on. It might be somebody who has a prior diagnosis but is not doing as well with whatever treatment plan they have. And so we’re making adjustments.
So I see the whole gamut. Just for perspective of what it looks like in the entire population of the U.S.:
About 1/5 of U.S. adults have a diagnosable mental health condition in a year. That’s about 40 million U.S. adults (CDC).
Looking at it differently, 50% of U.S. adults will have a diagnosable mental illness at some point in their life, and 50% of those people will have that diagnosis before the age of 14 (CDC).
In general, in the U.S., the most common mental health conditions are anxiety disorders, which I generally see in my practice.
The U.S. Healthcare System Is Failing Mental Health Patients
With this being a common issue, how well do I think the traditional system handles these patients? Well, let’s look at the statistics.
About 50-60% of patients with a mental health condition say they’ve received no treatment for their mental health disorder. 25% of patients said they tried to seek care but received no treatment.
So clearly, somehow, we’re not doing a good job. First of all, I would blame the traditional healthcare system.
I don’t think physicians are set up well in the traditional system to take care, identify, or manage these patients.
And it’s the typical shortcomings that are going to affect everybody—
- The access to care
- Insurance/Cost
- Short visits, which are going to affect the connection with the clinician
- Communication
- Lack of follow-ups
Everything. Full gamut.
But these issues will take a little bit more of a toll on patients with mental health conditions because they require a little more.
These patients need a little more finesse; they’re probably going to need more frequent follow-ups and a better listening ear. And so it’s going to hurt a little more in those scenarios.
Otherwise, I think the other big problem with mental health conditions is a big disconnect between how we treat physical health conditions and mental health conditions.
If We Treated Mental Health The Way We Treat Other Health Conditions:
Think about it—we’ve got all these public health campaigns around heart disease or hypertension on lifestyle factors, risk factor reduction, and things we can do to prevent these diseases.
Patients show up to the clinic for unrelated reasons, and we’re still checking your blood pressure even if they don’t typically have high blood pressure. Right? Why? Because we know that high blood pressure is common and we want to identify it so we can treat it quickly.
If we see the blood pressure rise over time, we’ll start to talk about it. We’re going to say, hey, you can change your diet, you can exercise, and we can get blood pressure down, or maybe eventually we’re going to have to jump on it, and we’re going to have to treat it because we don’t want those bad outcomes.
So the same should be true with mental health, right? If somebody comes in and isn’t feeling as well, and even in nondescript ways communicates that they’re just feeling low (their energy is low, they’re feeling tired for no reason, their mood is changing, they’re anxious), we should do something with that. But we’re not.
The delay in care for people with mental health conditions is by far longer than it is with physical health conditions.
Anxiety disorders can be as long as 9-23 years. Yeah, not months. Years.
For mood disorders, it’s 6-8 years. For psychosis, people hearing things or seeing things that aren’t there, or having delusional beliefs, the delay is 1-2 years. So clearly, we’re somehow not doing what we’re supposed to.
And again, I put some blame on the traditional system. I think society, all of us, take a little responsibility if there’s still that stigma that we need to work on. We’re starting to get there because we’re talking about it now, at least. But we still have a ways to go. Mental health is just as critical as physical health is.
How To Find Affordable & Convenient Mental Health Treatment In Primary Care
So how is treatment different at where I practice, First Primary Care? What can patients expect?
The biggest advantages are the time and connection with your clinician. We have unlimited time with patients and never, ever rush anyone out.
- Access—time and connection with your clinician
The starting point there will be just access. I mean, anybody could be as fantastic as they want, but if you can’t get to them, nothing will matter past that point.
At First Primary Care, you have direct access to your care team. Every clinician schedules a little differently, and every patient’s needs differ. But here, we have the freedom to schedule phone visits or video visits, or in-person visits.
We don’t accept insurance for primary care services; we charge a monthly fee for unlimited access. So, without insurance dictating things, we can do whatever we need.
This is important because it removes the barriers keeping patients from getting help and the care they need. If something comes up at work or with childcare, we can still take care of what we need to take care of.
2. Longer, un-timed visits
The other benefit is that we have the luxury of more extended visits. The acute visit in the traditional practice is about 15 minutes, and it’s pretty hard to do anything in 15 minutes. How fast can you talk? How quickly can I listen? Either you or I get to speak, but we can’t have it both ways in 15 minutes.
Our visits could be as long as an hour, and obviously, we could do more with that with our schedules. Also, we don’t overbook like many practices sometimes have to.
And so I’m not already thinking about the next patient in the next room as I walk into your exam room. We also don’t book our schedules for weeks in advance, making it easier for us to schedule follow-ups, which you will certainly need with mental health conditions.
It also gives us flexibility for when things come up because nobody plans for these things, right?
So when you have some need, we can actually see you instead of saying, “we’ll put you on the books in 3-6 weeks from now,” because that’s not helpful either.
And even between visits, we can stay in touch easily with our communication app, Spruce. Through the app, you can fire off questions as you think of them, text, or call about any needs.
It’s effortless to stay in touch that way.
3. On-going care, even when specialists get involved.
Of course, with mental health illness, there may be a time when we need to get somebody else involved. Maybe we need a counselor, perhaps we need a therapist, maybe we need a psychiatrist. And that’s all fine, right, as long as the outcome is improved health.
But we’re not just going to hot potato you to the next person. We will help facilitate that process and even stay involved along the way. Because we’re your primary care provider, right? That’s what we’re supposed to do.
And that’s the idea of this practice taking care of the whole of you for the whole time you’re with us. So it just allows us the time and connection with you to do that.
We all could benefit from a little extra care, time, and communication. If you’re ready to take that step and correct those statistics, congrats, you’re in the right place. Click the link below.
