This week, the Kem C. Gardner Policy Institute at the University of Utah released a report in collaboration with the Utah Hospital Association (my employer) on Utah’s mental health needs and the resources available to Utahns suffering from mental illness. The conclusions are sobering.
Mental Health America annually ranks each state and the District of Columbia for such factors as the prevalence of mental illness and addiction, unmet needs for treatment for serious mental illness or addiction, suicides, ideation of and attempted suicide and unmet need for treatment due to cost. Utah ranks 51st for adult mental health, although we rank 24th for youth measures and 37th overall.
The needs are great. Almost one in five adults experience poor mental health. Suicide is the leading cause of death for Utahns ages 10 to 24. Almost 40% of Utah’s depressed youth did not receive treatment for depression. Over half of Utah adults with mental illness failed to receive mental health treatment or counseling. Over 100,000 adults Utahns experience serious mental illness.
Notably, each day an average of 66 Utahns sustain a traumatic brain injury. That’s about 25,000 a year. These injuries can take months and even years to recover from; they may create lasting damage, impair intellectual functionality, decision-making and self-regulation. Sadly, 15% of new mothers experience postpartum depression symptoms, with that number increasing to 21% for low-income mothers.
One of the biggest barriers to proper mental health treatment is the stigma associated with behavioral health diseases and symptoms. It is still much more comfortable to talk about a broken leg or a heart attack than it is depression or anxiety, although so many of us face these symptoms from time to time or chronically. We must acknowledge that mental illness is legitimate and care for it is vital.
We must acknowledge that mental illness is legitimate and care for it is vital.
A major barrier to mental health treatment is the lack of psychiatrists and other skilled clinicians. The Gardner report details that shortage of professionals, especially in rural areas and for children seeking treatment from a mental health professional.
Payment for treatment is a major stumbling block. Lack of health insurance, high-deductible insurance policies, and poor mental health insurance benefits keep many from getting needed treatment. The average family has a hard time understanding their health care coverage, and even when they do understand it, they have hard time affording their share of the charges given that counseling and therapy can cost from $50 to $350 per hour.
An arcane split in how we handle Medicaid benefits is especially burdensome for the poor. Some years ago, Utah’s counties assumed the responsibility to provide mental health benefits to their residents on Medicaid. However, if a Medicaid mental health patient needs treatment for a physical ailment, the patient must seek care in the traditional health care system from a different provider. This makes for complexity that many simply cannot or will not navigate. Local mental health authorities do yeoman work with scarce resources and must be included as an important part of the solution. However, we must revise the outdated bifurcated treatment and payment system in Medicaid.
There is good news in that Utah’s Medicaid expansion, which began April 1, provides new Medicaid beneficiaries “integrated” coverage, meaning they can use one doctor to provide or refer the patient for all services, including mental health and substance abuse. We need to extend this to all Medicaid patients.
There is hope. The Utah Hospital Association and its member hospitals have joined with state policymakers, the Utah Department of Health, Department of Human Services, county mental health authorities, and Utah Medicaid to develop a master plan for mental health and substance abuse treatment services to become available to all Utahns, including crisis care for emergent mental conditions, inclination to commit suicide and other serious symptoms regardless of ability to pay or location within the state.
In Utah we collaborate with each other to solve our problems, even big problems. We have a looming challenge to provide adequate, affordable, accessible mental health services. Solving it will demand the best of us.