I’ve been spending some time thinking about access recently. My clinical caseload is a wide variety of incredible individuals in all stations of life, and I find myself thinking about what they struggle with, and the courage they exhibit in working through the challenges they face.
Just like you.
One of the things that I continue to wrestle with is the disparity in access to care. We all know that access in the US is much about how much one can afford to pay.
According to the National Institute of Mental Health, one in five adults in the United States live with a mental illness. According to SAMHSA, “service cost or lack of insurance coverage was the most frequently cited reason for not using mental health services across all racial/ethnic groups.” This means that, while the incidence of mental illness across the country is about the same, those people who tend to do better are those that can afford to get great access to care.
I don’t write this for guilt impact. I am just saying out loud what we all know.
There are a lot of people out there that continue to suffer with mental health issues, facing complicated life stressors – low financial capacities, insecure housing, reduced access to transportation, and in some cases a less safe world to live in. We add lack of access to affordable mental health care, and we see those complexities rise in attempts toward wellness.
While we see concentrations of this in urban settings, this is not just an urban problem. Back in 1980’s, when I was in seminary at the University of Denver, I would volunteer in soup kitchen from time to time in Denver. There was a broad range of people who ate there from a wide range of circumstances. The homeless include people from the city but would also include people from more rural settings where families had lost their farm or ranch and were now living in their car, looking for assistance wherever they could find it. Those of us who have worked in support of rural areas have experienced the particular challenges of rendering support and care. Care centers are a long distance away from the client's home, making it difficult to provide effective care.
Lack of access to good mental health care has significant impacts. Death rates by suicide is more common in American indigenous people and Alaska natives than the general population. The rates are also higher in rural areas. Children in disenfranchised groups with autism are generally diagnosed later in their life, which leads to later initiation in treatment, which leads to less positive outcomes. Good quality care is simply not available to those that need it, and we are left in a circumstance where there are those that receive help and those who wait. And the inequities in that system are reflected in the average length of life, quality of life, rates of disability, severity of illness, and access to treatment. Mental health equity will be achieved when all people have the opportunity to attain their full health potential, and no one is impeded from doing so because of socially determined circumstances.
There is some good news in all this. There are a number of studies from various public health sectors who are attempting to better understand how to help these sectors, to better deploy services to those individuals who need it. It takes dedicated people who have a passion for this work to be a part of these efforts. Certainly, more has to be done.
Whenever I have the opportunity to talk to younger clinicians just coming out of grad school looking for a first clinical job, I tend to encourage them to consider going to work at a community mental health center, Rural Health Center (RHC), or Federally Qualified Health Center (FQHC). These programs are notoriously understaffed and are constantly in need of good and energetic staff for a population who needs their help.
For those of us who are in private practice or are fortunate enough to be running a thriving group practice, maybe we can find a way (if we haven’t already) to open up some limited time for sliding scale clients. To make it more accessible, even enroll in a network like the one Open Path Psychotherapy Collective (www.openpathcollective.org) has developed. When you do this, you make yourself open to a broader range of people who are also in need and that you can help.