Almost 60 percent of American adults with mental illnesses do not obtain treatment, and they are scattered among blue, red, and swing states.
That’s the message of the 2017 edition of The State of Mental Health in America, an annual report published by the nonprofit organization Mental Health America (MHA).
MHA ranked all 50 states and the District of Columbia on their share of people diagnosed with a mental illness or depression who did not receive treatment, lacked health insurance coverage for their condition, decided treatment for their condition was cost-prohibitive, or fit other criteria relevant in 2014, the report states.
The four states with the best conditions for treating mental illness are Connecticut, Massachusetts, Vermont, and South Dakota, in that order, the study found. The lowest-ranking states are Nevada, Arizona, Oregon, and Idaho.
New Mexico and Oklahoma climbed from the top 40 states in the 2016 edition to the top 24 in the current volume. Indiana and Wisconsin fell by at least 25 slots since last year.
States with the lowest mental health care workforce had the highest incarceration rates, the report states.
Rankings were distributed among states across the political spectrum, “but political environments in states do seem to matter,” MHA President and CEO Paul Gionfriddo said in a press release accompanying the report. “Those that invest more in mental health clearly have to throw away less money on jails and prisons,” Gionfriddo said.
Free-Market Mental Health
Dr. Bob Emmons has maintained a private, fee-for-service psychiatric practice in Burlington, Vermont for 27 years. Emmons says an increase in the number of psychiatrists, not more public funding for psychiatry, is the best way to expand access to mental health services.
“A larger supply of psychiatrists would do more than public funding to address long waits for treatment,” Emmons said.
Emmons says he credits his practice’s success to his elimination of government and insurers from the psychiatrist-patient relationship.
“My practice, with true market-value fees, is busier than ever, as third-party payers set fees further and further below true market value for my colleagues who bill them,” Emmons said. “I have opted out of Medicare, which means that Medicare beneficiaries in my practice—and I see many—all pay my regular fee.”
Contrary to the value MHA’s rankings place on insurance, Emmons says patients who pay for their own treatment get faster and cheaper access than insured patients.
“My kind of direct-pay practice is suitable for all medical specialties, not just psychiatry, because it increases access and lowers costs,” Emmons said. “My fee is half the fee at the local hospital.”
Government, Insurer Obstruction
Dr. Kathy Platoni, a practicing clinical psychologist in Centerville, Ohio, is a retired U.S. Army colonel who treated patients during multiple deployments to the Middle East and was serving at Fort Hood, Texas at the time of the 2009 mass shooting.
Platoni says low reimbursement rates have caused her to reject some insurers as payers.
“Most insurance companies reimburse at such a ridiculously low rate, clinicians, at least in private practice, are less apt to conduct [the necessary] assessments,” Platoni said. “Some insurance companies refuse to reimburse for these services at all. I have dropped out of several in protest.”
In addition to the problems with private insurance, Medicare, which is funded by federal taxpayers, inhibits mental health patient access by reimbursing clinicians below their market value and burdening them with excessive reporting requirements.
“We are given the choice of administering four screening measures or be penalized with a reduced reimbursement rate,” Platoni said. “Patients are very angry about this, in my experience, [because] this cuts into their session time, and Medicare does not pay for the administration of these psychological screening devices.”
Platoni says the government’s requirement Medicare providers do more work for the same or less pay could cause her to stop serving Medicare patients.
“I only see a further decline in reimbursement rates and increasing workloads,” Platoni said. “For this reason, I probably will refuse to see Medicare patients in the near future. How very sad that it has come to this.”
Tony Corvo ([email protected]) writes from Beavercreek, Ohio.
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