WE MUST MAKE MENTAL HEALTH CARE ROUTINE, ACCESSIBLE

By all accounts, the United States and the world are in a continuous and escalating mental health crisis. Aside from statistical evidence, we see this crisis in emergency rooms, schools from K-12 through university, on our streets, in our homes and in the headlines. These situations require an overwhelming and costly response, and our attention in each of these settings is diverted to either addressing an out-of-control event or tending to those impacted by someone who has self-harmed, has required hospitalization, has been arrested or, in rare cases, has harmed others. When the situation is unrelenting and accompanied by other, related crises — of the COVID-19 pandemic, opioid addiction, economic uncertainty and social upheaval — we find ourselves dedicating ever-increasing resources to crisis response. In the midst of this necessary response, I would like to advocate for building a mental health system that is de-stigmatized and accessible.

Each individual mental health crisis likely represents a missed opportunity for early, effective intervention.

I mention de-stigmatization first because an effective and accessible mental health system requires a population that sees mental health as a routine aspect of overall health. We have made strides in our public discourse around mental health; athletes and other public figures who have openly discussed experiences with depression and anxiety have helped in the process of normalizing experiences that are likely to affect 50 percent or more of the population during a lifetime. We also have seen a remarkable shift in routine medical care, and screening for depression, substance misuse and domestic violence are now as routine at the doctor’s office as taking a temperature or checking blood pressure. A referral to a therapist or counselor must become not a response to crisis but a routine part of medical care, school counseling, pastoral care and even family life.

With de-stigmatization and routine mental health check-in and referral comes the next heavy lift: providing a workforce of mental health providers at all levels to serve these needs. When an individual or family accepts the need for mental health care, they may not find a provider whom they can afford, who will speak their language and/or who will have an appointment available in any reasonable time frame. According to the nonprofit advocacy organization Mental Health America, in 2021, California ranked 45th among U.S. states with 66 percent of youth with untreated major depression and 49th for untreated adults with a mental illness, with 65 percent of adults not receiving the mental health services they needed.

Each time people are discouraged by lack of access to care, they move one step closer to crisis. The solution to developing a workforce capable of meeting the needs of the population is multifaceted. Many programs are in place and simply need to be scaled to incentivize our best and brightest to pursue careers in mental health care and to spend at least some of their career in public sector or community mental health. Public service loan forgiveness at the federal level and the Licensed Mental Health Services Provider Education Program in California are examples of popular programs that can be expanded and strengthened to encourage students to pursue the advanced degrees to become licensed providers.

An accessible mental health care system requires coordination and integration. There should be no wrong door into mental health treatment. School districts, police and sheriff departments, and health care networks need to continue to embed mental health practitioners in their systems, providing the opportunity for a first responder who is dealing with someone with an identified need for mental health care to offer a direct, face to face introduction and referral to a trained mental health professional who can engage with them before the crisis begins.

Finally, our health care system needs continued reform to make sure that mental health services are provided with parity to all health care services and that mental health providers at all levels are reimbursed by public and private payers at rates that support the education and dedication it takes to do this work.

The mental health crisis is neither new nor mysterious. The solution is to make mental health care both routine and easily accessible.

There should be no wrong door into mental health treatment. School districts, police and sheriff departments, and health care networks need to embed mental health practitioners in their systems.