Introduction
Mental health disorders have become common globally, thus mental disorders are an issue of concern. About 44 million adults and 14 million children are affected by mental illness annually in the United States (Russell, 2010). The cost of meeting the needs of the mentally ill has increased significantly. Virtually all countries are struggling with the increasing health demands occasioned by increases in cases of mental illnesses. The low-income countries are the most burdened. Mental health disorders have been strongly attributed to the skyrocketing cases of suicide across the globe. Suicide is among the leading causes of mortality in the United States. Surprisingly, 80%-90% of suicide cases are due to mental illnesses. Therefore, mental health disorder cases deserve a lot of attention.
Statistics indicate that mental illnesses are costing the government heavily given that about $317 billion were committed to mental illnesses in 2008 only (Russell, 2010). It should also be considered there are extra costs that come with mental illnesses that are not included in the figure above. They include the cost of other conditions that occur together with mental illnesses, as well as the cost of incarceration, among others. Russell (2010) indicates that mental health illnesses are more prevalent among persons with chronic conditions like asthma. This implies that it is not enough to treat one of the conditions; rather, treating both conditions results in better outcomes. It has been suggested that incorporating mental health with primary health care could be a solution. This paper explores the integration of mental health with health care in the United States.
Main Body
The integration of mental with health care refers to a situation in which the mental health specialty and the general medical care providers collaborate to address both physical, as well as mental health needs. It has been suggested that the surest way of attaining quality and equality in the provision of health care is merging primary care with mental health care. This should also involve the provision of services related to substance abuse. This suggestion is based on the observation that most people who suffer from deteriorated mental health fail to receive treatment because of obtaining primary care only and failure to obtain mental health care at the same time. This emphasizes the need to amalgamate primary care with primary in the US health care system. However, the questions that remain revolve around how to integrate these two sectors of health care in an optimal manner. One sure thing is that integrating these two forms of healthcare is surrounded by a myriad of challenges. They include the huge number of mental disorders, the intertwined nature of the two sectors, greater affordability, as well as better and cost-effective care. There is also reduced patient and family stigma, protection of human rights, reduced chronicity and better social incorporation, as well as the betterment of human resource capacity for mental health (Russell, 2010).
One of the major barriers to the timely diagnosis, care, and treatment of mental disorders is the scarcity of mental health providers and the shortage of mental health services. Mental health workers are in scarcity. The shortage of psychiatrists is severe. A survey conducted in the United States revealed a very severe shortage of psychiatrists, as well as other mental health professionals (Russell, 2010). Even the few professionals who are available have been populated in the urban areas, leaving the rural areas disadvantaged. Prescribing antipsychotics is left in the hands of a few mental health professionals; “advanced nurses and psychiatrists”. For example, there are less than 40,000 psychiatrists who can prescribe psychotic drugs in the United States. The number of advanced nurses is even lower, standing at about 8,000. This number is by far very small given the high population that needs health attention. It is, therefore, a major setback to the management of mental disorders. The outcome of an assessment conducted in the US indicated that about 353,398 providers were clinically active across six mental health professions. These included advanced psychiatric nurses, professional counselors who are licensed, psychiatrists, psychologists, marriage/family therapists, as well as social workers. It was further determined that the ratio of providers to the population is uneven all over the nation, whereby the number of licensed counselors and social workers stands highest while the number of psychiatrists and advanced psychiatric nurses was the lowest (Freedman, 2009).
As noted earlier, suicide cases are directly proportional to mental disorder cases. It has also been noted that the more the number of mental health professionals, the lower the suicide cases. It is, thus, very evident that the shortage of mental health professionals is a major drawback that should be addressed promptly because it has a direct impact on the management of mental illnesses and suicide cases (Russell, 2010). However, besides the indication of the scarcity of mental health professionals on the numerous mental health needs that fail to be sufficiently met, the uneven situation of service utilization currently in the United States leaves a lot to be desired. For instance, adults who are seriously mentally ill, like in psychosis cases, are said to spend about eleven hours with a non-prescriber mental health professional in a year, while only about 5 hours are spent with prescribers/primary care physicians. On the other hand, those with less serious mental cases like depression or anxiety take roughly 8 minutes with non-prescribers and about 13 minutes with mental health prescribers/primary care professionals (Hudson, 2009).
It is arguable that access to mental health care services will be restricted significantly, unless mental health is integrated with primary health care. The primary health care workforce is capable of providing mental health assistance. More than half of the mentally ill individuals who have been treated are under some form of primary care by the primary care providers. Evidently, the United States appears to progressively embrace the use of primary care in mental health significantly. It is demoralizing to note that the intensity, as well as the quality of the mental health treatment being offered is still unevenly distributed and shallow. For example, estimates indicate that only about a third of mental health cases received in the primary care is accorded the minimal satisfactory care. Numerous cases do not get recognized, thus only a few are treated (Hudson, 2009). It is very pertinent for mental health training to be incorporated in basic training, post-basic training, as well as continuing professional development everywhere, owing to the severe shortage of mental health care providers (Russell, 2010). Medical officers in the outpatient department, public health nurses, and public health inspectors should all have basic mental health training to provide primary care to mentally ill patients. Many positive results are possible if frontline mental health care is optimally provided in the primary care settings at the right time. The positive attributes include practitioner and provider satisfaction, cost-effectiveness, patient improvement, improved clinical outcomes, as well as better adherence to regimens and treatment for mental illnesses. Furthermore, this will reduce stigma against the mentally affected individuals (Butler et al., 2009).
The quality of mental health care services that is offered is very important. As noted, the integration of mental health with primary health care yields quality services. While there is evidence of the management of mental disorders, it is still notable that many patients do not receive effective treatment. Statistics show that less than 10% of the individuals diagnosed with depression in the United States benefit from therapy. There is the biggest challenge of having mental health patients comply with their treatment regimens and appointments (Hudson, 2009). It is, therefore, important to improve patient compliance. Employing the use of evidence-based protocols will go a long way in improving the detection, as well as the treatment of depression in primary health care. This will, in turn, reduce the suicide cases, minimize or prevent relapse symptoms, and generally improve the results of mental health treatment (Russell, 2010). Further, access to quality psychotropic treatment where resources seem to be low can be addressed by soliciting assistance from drug companies by requesting the companies to lower the prices of the psychotropic drugs, just like it has been the case with antiretroviral (Butler et al., 2009).
It is also important to consider the perceptions of the patients regarding the whole issue of mental disorders, diagnosis, treatment, care, and integration with primary medical care. People are still reluctant to go for mental medical care. People generally do not recognize the clinical basis of the problems facing them. Among the main reasons barring individuals from seeking medical care when it comes to mental problems is stigma. Stigma further results in low self-esteem, reduced access to resources by the patient, and isolation. Stigma is more pronounced in rural areas compared to urban centers of the United States. It is also common among the younger children and the aged (Russell, 2010). Mental health illiteracy is another barrier that affects access to mental medication. Perceptions regarding mental health professional aid and treatment play a great role too. For instance, if a patient believes that it will not help to consult a psychiatrist, then their chances of receiving appropriate help are very minimal. Analysis across the US has shown that people possess a low opinion towards psychotic medication, partly due to their side effects and partly because of the deep-rooted belief that the medications only deal with symptoms as opposed to the main cause (Russell, 2010). This calls for the provision of public education and sensitization to help patients understand the disorders and how to manage the stigma that would be crop up. The mental health management approaches should also put more emphasis on recovery. This can be done through education programs and interaction with individuals with mental illnesses in schools, as well as other public institutions (Butler et al., 2009).
Mental illnesses do not occur in isolation. They are often accompanied by numerous other health problems that further compound treatment and make it more expensive. For instance, diabetic patients who have comorbid depression incur roughly five times higher health care costs compared to those who are only diabetic. Chronically ill patients are more prone to anxiety and depression compared to people without chronic illnesses. It is, thus, vital that better and early screening and treatment for mental health disorders of chronically ill patients be conducted. This will go a long way in reducing distress and risk complications, as well as suicide. Better physical care provision is also imperative because it plays a major role in the overall management of such kinds of health complications (Russell, 2010). Depression, anxiety, and psychotic disorders, among other conditions are more common in teenage, as well as early adult life. About half of the cases of the mental disorder commence at the age of fourteen. About 14%-20% of young children and teenagers suffer from a mental health illness annually. However, only a quarter of these children and teenagers receive treatment. There is a serious need for early intervention in mental health illnesses because these disorders increase mortality and are bound to result in epochs of disability and unfulfilled lives later on (National Institute of Mental Health, 2009).
Another barrier to the implementation of the idea of integration of mental health with primary health care is the reluctance to adopt change (Butler et al., 2009). It has been argued that human beings are generally opposed to change, regardless of whether it is positive or negative change. Substantial efforts must be put to make individuals embrace integration readily. However, providers may not be ready to invest in such kinds of efforts. Primary care providers, for instance, would consider mental health services as being out of their responsibilities because they have been specifically trained to work in general medical care. Further, healthcare providers may be reluctant to adopt the integration because it would mean they give more time than they would if they were dealing with general health care services. It, therefore, calls for a serious leader who is willing to promote, advocate, and support the integration (Russell, 2010).
Despite the challenges, the integration of mental health with primary health care has numerous benefits. Many positive outcomes have been reported in places where integration has been embraced. Studies have determined that there is evidence of a growing bid to incorporate comprehensive integrated mental health into condition-specific protocols involved in the care management. Generally speaking, integrated care has brought about many positive outcomes. Nevertheless, it is impossible to tell apart the effects that would come as a result of increased general attention to mental health problems from those of particular strategies. This lack of correlation underlines the underlying question regarding the specific outcomes of integrated care. However, it is sensible to argue that the introduction of a systematic strategy and additional consideration for treating mental problems in the context of health care will lead to a beneficial outcome (Russell, 2010). It goes without saying that the financial barriers that come as a result of fee-for-service payment have to be reckoned with while struggling to put in place integrated care for mental health and physical health patients. A lot of effort and determination are required to implement the idea of integration. No barrier can prevent the integration of mental health with primary health care once the benefits of adopting integration are recognized.
Conclusion
Health care inequality and poor quality when it comes to mental health care compared to primary health care call for amalgamating the two sectors of the health care system. The positive outcomes expected from integrating mental health care with primary health care include increasing accessibility to mental health services as the main outcome. It is also expected that mentally ill patients will experience improved physical health, especially those suffering from chronic conditions such as comorbid conditions. Finally, achieving full integration will mean that the present inequalities in health care that touches on the mentally ill will be addressed to a great extent.
References
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Freedman, R. (2009). Matching patients and providers across the United States. Psychiatric Services, 60(10), 1293. Web.
Hudson, C. (2009). Validation of a model for estimating state and local prevalence of serious mental illness. International Journal of Methods in Psychiatric Research 18(4), 251–264.
National Institute of Mental Health (2009). Treatment of children with mental disorders. Web.
Russell, L. (2010). Mental health care services in primary care: Tackling the issues in the context of health care reform. Web.