Imagine being told: "He thinks he will die soon and he doesn’t like what he sees in the mirror."
If your first thought was: "What? They’re crazy!" You’re not alone.
These words are spoken day in and day out from individuals with mental illnesses themselves, but they're often pushed to the side due to the stigma of mental health. And since May is Mental Health Awareness Month, there’s no time like the present to discuss what can be done.
Because of that stigma, it's harder for people who may need help to seek out the resources that are available to them. Since there’s no uniform treatment, the National Alliance on Mental Illness (NAMI) states that untreated mental illness leads to more emergency department visits, hospitalizations, school failures, incarcerations, suicides and more suffering by individuals with mental illness and their families — and increases overall healthcare costs.
"It is treatment very often just where you can find it or afford it," NAMI Mid-Tidewater, Virginia, Programs Administrator Sandra Mottesheard MS, CRC, CRP, said. And those individuals who don’t think they’re sick — anosognosia — are often found living on the streets.
"We need to create more treatment facilities for our sickest and put more money into not just community based services but housing and assisted outpatient treatment.We can treat individuals with mental illness if the money is there to create treatment facilities and train the necessary professionals," Mottesheard said.
It's been said that the lack of quality treatment facilities was due to lack of insurance, but when President Obama offered a solution, some states refused it.
Since the start of the Affordable Care Act, it's been creating a divide in mental healthcare since more individuals are receiving more treatment in the East, Mid-Atlantic and Pacific regions, whereas those in the South and Central U.S. are not.
According to a report from the American Mental Health Counselors Association, about 1.1 million uninsured individuals — living in 24 states that did not participate in the new Medicaid Expansion Program — had been diagnosed with a severe mental illness were denied access to — affordable — treatments. If these states had participated in the expansion, the necessary treatments for the individuals would have been paid fully by the federal government. The states "rejected the new coverage initiative in 2014 based on ideological intransigence, not health or fiscal interests." The report states that if the 24 states had expanded Medicaid, they would have saved billions of dollars and created numerous jobs.
Since Mottesheard resides and works with a NAMI affiliate of Virginia, she was upset to hear that her state was one of the 24 that did not participate in the expansion program. "The expansion would help cover some 70,000 uninsured Virginians with mental illness, which includes children with disabilities who often are not qualifying for Social Security Disability and have aged out of Medicaid for children."
Those people who don't get treatment for mental illness can end up in jail or homeless. In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that about 30 percent of homeless people are considered to have a severe mental illness. According to a study published in Health Services Research, public insurance programs are the major points of leverage for improving access and policy interventions should be targeted to these programs.
On the contrary, 26 states and Washington, D.C., did participate in the expansion and were able to help about 400,000 individuals with mental illness who needed affordable treatment, thus decreasing the amount of individuals who developed a depressive disorder due to obtaining health insurance coverage.
Insurance isn’t the only item of agenda in order to help these individuals. More trainings can also be useful for healthcare professionals. "Healthcare professionals can learn more about the different mental health disorders and try to understand how mental illness affects behavior," Mottesheard said. With the understanding of behaviors associated with symptoms, it can be more easily recognized and treatable. "Professionals can [then] take the time to talk to family members who offer a wealth of information that ultimately helps the illness," she said.
A survey from NAMI stated that primary care physicians are critical to detecting mental illnesses in children and that the most ideal actions steps for healthcare professionals are to:
- Listen
- Ask questions
- Screen
- Evaluate
- Refer
- Follow-up
- Provide treatment
- Encourage
With the help of primary care physicians, these individuals could be on their way to receiving the treatments needed, especially since the National Resident Matching Program report shows that the number of U.S. psychiatrists is steadily decreasing. "We need an integrated healthcare delivery system, and psychologists must be a part of the healthcare teams in that system…," American Psychological Association Executive Director Katherine Nordal said.
If we had more highly-trained mental health professionals including social workers, nurses, psychologists, support groups, etc., it would motivate help in order to control mental health issues and continue in the discovery of treatment. "There are more free flowing ideas and the science of the brain is better than ever, but we still have a long way to go," Mottesheard said.
Although research has gone far to understand the impact of mental health, it has only recently begun to explain stigma in mental illness. With that said, according to a study published in World Psychiatry, "stigmatizing views about mental illness are not limited to uninformed members of the general public; even well-trained professionals from most mental health disciplines subscribe to stereotypes about mental illness."
In a recent Washington Post article, an anonymous woman stated that a mental health individual should, "Be glad that … bipolar disorder … is all you have. It could be worse, you could have cancer or some other terminal illness.…" In response to the comment, the individual wrote, "It saddens me that so many people do not realize that mental illness, while treatable, is not a curable disease and can lead to death."
Lack of education, fear of disclosure, rejection of friends and discrimination are just a few reasons why people with mental illnesses don’t seek help … it’s an ongoing issue, but with collaboration we can change the scope of practice and life.
So wherever you fit in, whether it's healthcare professional, general public, family of an individual with mental illness, or someone else impacted by mental illness, take the proper steps to learn all you can about mental health. It's guaranteed that you know or will meet someone with a mental illness since 1 in 5 Americans suffer from one. It's time to step away from the fear and move closer to allowing individuals with mental illnesses to receive the proper help and care they deserve.
"Mental illness is not contagious," Mottesheard said, "We decided that we needed excellent treatment centers for cancer and we have them now. We need to decide those with mental illness deserve the same."
Take it from me, mental health needs a spotlight on it because you don’t want to hear the words, "He thinks he will die soon…" like I did.
