Like most Americans, I often start my day on my phone, catching up on the major news of the day, reading newsletters, or listening to a podcast. As a psychiatrist and the CEO of Mindful Care, a multistate mental health provider, I pay particularly close attention to how mental health is being discussed among the general public and in media. Lately, I've noticed a new tone to mental health coverage. After years of discouraging reports about increases in loneliness, mental health diagnoses, and overdoses, outlets and authors are trying to strike a hopeful chord. Increasingly, I see coverage focused on "promising new programs" or "revolutionary treatments." These stories gush over exciting new ideas and scientific developments sure to save us from our national despair.
After years of worsening mental health statistics, we want a simple fix. Take this hopeful newsletter about suicide prevention efforts, for example. The piece details how "means restriction," or reducing access to particularly lethal methods of taking your own life, can significantly reduce overall suicide rates. The piece is hopeful. The newsletter seems to tell us, "Look, here's a simple, effective solution that we can use to save lives! What are we waiting for?"
For me, this style of coverage inspires frustration, not hope. I am deeply familiar with the world of mental health treatment, as a practitioner and a provider, and regrettably, there are no silver bullets. Without broadly improving access to mental health care, small interventions, like means restriction, are nothing more than a Band-Aid papering over a deeper crisis, distracting us from the real change we need.
To be clear, I am not disputing that means restriction can be helpful. This kind of small intervention can improve conditions somewhat. Nations like the United Kingdom and Sri Lanka have successfully reduced the number of suicide deaths by restricting access to toxic chemicals and gases. But in the United States—where firearms are responsible for more than half of suicide deaths—means restriction is practically synonymous with gun restriction, and activists have failed for decades to pass gun control legislation. Given these fundamentals, it's hard to imagine means restriction succeeding in the U.S. Why spend time discussing a small intervention unlikely to work here?
I understand the urge to strike a hopeful tone in the national conversation about mental health. Our present is bleak. Suicide deaths are on the rise in America. Nearly 50,000 people die from suicide each year in the U.S. We lose even more to so-called deaths of despair, those caused by suicide but also overdose and substance use. In this vortex of grim news, it is tempting to look for a silver lining—or a silver bullet. It feels good to read a short piece that imagines a better future. But reality beckons.
An exciting new depression study or a few state-level red flag laws cannot fix our mental health crisis. The underlying problem is access to mental health care, particularly for individuals with severe mental health issues. A safety net under a bridge might catch someone who tries to jump. Restricting access to guns might make it more difficult to complete a suicide attempt. But what happens next? We still have a person contending with a serious mental health condition. They will still need care, but where do you turn for help?
The average patient has to wait six to eight weeks before they can see a mental health provider. Accessing care is even more difficult for patients with public insurance or no insurance at all. Patients with severe diagnoses, who must see a psychiatrist who can provide medication management, face even more barriers.
I run one of the largest psychiatric urgent care chains in the country. We accept all patients, even those with Medicaid or no insurance, because I believe in the importance of easy access to mental health treatment. Because of this commitment, we see many patients at a financial loss.
Our health care system is not set up to serve patients with difficult diagnoses and complex treatment histories. Medicare and Medicaid only pay providers a few dollars an hour. Insurance companies constantly push for shorter and fewer appointments. For many psychiatrists and therapists, it is not financially feasible to take on patients with severe mental health diagnoses like schizophrenia, bipolar disorder, and major depressive disorder. The insurance reimbursement structure actively discourages it.
Subsequently, many behavioral health practices cannot afford to see high needs patients. Providers, like Mindful Care, that will see every patient, must balance high needs clients with those who are wealthier and self-pay or have high quality private insurance.
It is comforting to read about simple solutions, but our nation's mental health crisis is serious and complex. The problems of access to care are not easily solved. A major overhaul to our health care laws and insurance reimbursement structure is likely needed to improve access to mental health care in this country. Yet, this is a problem that we must face with clear eyes—no matter how demoralizing these crises may be.
Dr. Tamir Aldad is a fellowship trained addiction psychiatrist and the founder and CEO of Mindful Care—the award winning first-ever psychiatric urgent care in the United States. Dr. Aldad graduated with an MBA from University of Chicago Booth School of Business, and completed residency and fellowship training at Northwell Health, after graduating medical school. He also conducted several years of behavioral health research as a physician scientist at Yale School of Medicine. He is passionate about acute mental health issues, public mental health, and improving access to affordable care.
The views expressed in this article are the writer's own.
