Preventive care for mental illness in the U.S.: Are we asleep at the switch?
The Affordable Care Act of 2010 is the first major national health care legislation that mandates a shift away from acute care and toward preventive care. Under the Act, health insurers must cover preventive health care services ranging from annual physicals, mammograms and even birth control at no out-of-pocket cost to the consumer. Federal policymakers are continuously expanding the list of required preventive health care services that fall under the Act. But one area of health care where preventive services are decidedly lacking is mental health. What can we do to address this problem?
“We don’t have parity between medical coverage and behavioral health coverage in this country,” says a psychiatric nurse and University of Phoenix faculty member, who wishes to remain anonymous. “Mentally ill individuals are considered an underserved and vulnerable population. Unfortunately, behavioral health benefits are limited by insurers in many ways — restrictions on inpatient days, number of counseling sessions, etc., and these limitations prevent individuals from getting the treatment they need.”
With basic mental health care difficult to obtain even under the best of circumstances, some patients and their families act out of desperation in search of care, according to our source. “The sad part is, the jails are picking up the slack and becoming a primary source for mental health treatment for inmates with mental health disorders. And for some parents, having their teenager in juvenile detention may be the only way they can get mental health treatment,” this psychiatric nurse says.
Too little, too late?
Another problem is the fact that most mental health care in the United States is symptom-based, rather than preventive in nature. Park S. Balevre, RN, MSN, is a retired psychiatric nurse as well as an area chair for Nursing at the North Florida Campus of University of Phoenix, and he, too, is saddened by the lack of affordable and effective treatment options for the mentally ill, especially in terms of prevention.
“One recurrent theme in the mental health nursing texts is our inability to identify the mentally ill population at the primary intervention stage — the stage before the acute illness begins,” says Balevre. “This early phase is often marked by mild personality disorders, like the ‘weird guy,’ or the hysteric or the loner. But since there is no blood test per se for schizophrenia or bipolar disorder or depression, the treatment comes with the behavior — always too late.”
Some promising alternatives still exist
However, the news isn’t all bad. According to Balevre, there are currently multiple programs nationwide that are having some success when it comes to implementing more proactive treatments for the chronically mentally ill patient population, including one in his home state of Florida.
“The Florida Assertive Community Treatment Team (FACT) is a strong evidence-based model using a case management approach to delivering one-on-one intervention to mental health patients,” he says. “I’ve seen this team track down homeless schizophrenics to make sure they were taking their medication, help recovering bipolar patients secure jobs, and link dual-diagnosis patients to treatment programs and housing sources. This type of proactive community initiative seems like the best option we have right now.”