The Top 10 Problems with Mental Health Care and How it Hurts Patients.
#1 – Poor reimbursements for services- All psychiatric services are reimbursed at rates much lower than other medical specialties. In particular, psychotherapy has very low reimbursement rates which makes it difficult for psychiatrists to offer this service.
#2 – Not enough psychiatrists – The number of American psychiatrists continues to shrink and the USA cannot fill the residency positions for psychiatry. Why? Psychiatrists are also stigmatized amongst other medical professions and salaries are traditionally much lower than other specialities.
#3 – Not enough inpatient psychiatry beds – Nationwide this is a trend, but in North Carolina it is dramatic. Less inpatient beds means that patients are stuck in emergency rooms for sometimes weeks at a time. Patients have very short hospital stays and are often released from the hospital before they are truly “ready”due to bed shortages.
#4 – STIGMA – I cannot emphasize this one enough. There is still a vast amount of stigma surrounding mental health, for doctors and patients alike. This makes people more reluctant to get help until they reach a crisis stage, and makes doctors less likely to choose psychiatry as a specialty.
#5 – Media coverage – Investigative reporting will focus on tragedies and negative outcomes in mental health, instead of focusing on recovery stories and positive outcomes. Sometimes the reporting “blames”the psychiatrists or the patients rather than looking at the problems in the system.
#6 – Inaccurate internet material – There is so much information it is difficult to know what is reliable information. There are many social media venues for people to tell their stories, which is a good thing. However, reading these stories without having the big picture can bias people and make them afraid of treatment.
#7 – Lack of innovation in pharma- Most pharmaceutical companies are cutting the amount of resources they dedicate to neuroscience / psychiatric medications. This is largely economic and based recent disappointing medication failures.
#8 – Disconnect between research and clinical work – There are many, many years between research and clinical work. Additionally, the research samples are often not reflective of real-world samples, making it difficult for clinicians to apply research findings to their work.
#9 – Corporate medical decision making – At insurance companies and in the community, more and more pressure is being put on cost-savings. Since mental health providers are typically not experienced in business, this work ends up being given to business people who are not clinicians or providers.
#10 – STIGMA – again! I am repeating this one because in some ways this is the most significant problem of all. With less stigma it would be easier to get accurate information and educate each other about mental health.
We have a long way to go and more of us need to start educating the public and standing out.
Dr. Jennie Byrne