Mental health has a problem and, and it’s not the patients who are at fault but the funders, planners, and administrators.

People in the United States today are experiencing one of the most traumatic errors that we can imagine, and, as a result, both stress and mental health disorders are at an all-time high. We don't need to look at the 2023 Stress in America survey by the American Psychological Association to know that we need mental healthcare, and it's not there. Let's look at some facts.

According to the study, people ages 35 to 44 experienced the most significant rise in chronic health conditions since the pandemic (58% in 2023 vs. 48%). Also, the number of mental health diagnoses rose the most among adults aged 35 to 44 (45% reported a mental illness in 2023 compared to 31% in 2019). However, adults aged 18 to 34 still had the highest rate of mental illnesses (50% in 2023). Today, adults ages 35 to 44 were more likely than in 2019 to say that money (77% vs. 65%) and the economy (74% vs. 51%) are the main things that stress them out.

When there is such a noticeable increase in the number of people receiving mental health diagnoses, what needs to be done? The service sector is overwhelmed and has created longer waitlists than ever for people seeking appointments. Being on a waitlist is no help or little help to those who are suffering psychologically, which can cause some types of medical illness or even suicide.

What is causing this situation to be so grave and not immediately remedied? Who is providing the funding, and where is it going? Where are the desperately needed workers, and who is training them? And what about the scores of children who require services?

Parents want their child to get the right care right away when their child or teen is having a behavioral health crisis, like a mental health problem, an eating disorder, a drug use disorder, etc. Their reaction is the same, whether their teen broke their arm in a bike accident or had a seizure. Even if a child or teen has health insurance (private or Medicaid), help may not be on the way when they are having a mental health problem.

I know of a recent instance when a mother brought her son for an intake for mental health services. He was having serious panic attacks and was refusing to do anything. Unfortunately, Medicaid covered him. The worker asked for information that no one except artificial intelligence could provide, and the mother was told she was being resistant.

"We're trying to help you, but you are not willing to work with us,” she was told. After an exasperating one hour with the woman, the mother was told there were no appointments and that she would be called if one opened up. The boy still experiences daily panic attacks, and there is no one to provide help for him.

Who can the family turn to? Unfortunately, the only option for most families is either a pediatrician or a family physician. Primary care offices are where about 40% of visits for mental health issues like depression and anxiety happen, and they write 47% of prescriptions for any mental health disorders.

Financial incentives are one reason for the paucity of mental health professionals. Low reimbursement rates, especially for Medicaid, lead to providers opting out of the mental health system or insisting on payment at the time of service. Of course, they may opt out by indicating no available appointments for at least six months (note the example above), and the individual will be called if an appointment opens up. If the individual has insurance coverage, they may be asked for a high co-pay or prior authorization or told they will receive a limited number of therapy sessions.

Fees charged by individual psychotherapists (usually social workers or psychologists) in major areas of the country run about $300-$500 a session, and many of them don't take insurance or only specific higher–paying insurance. When Medicaid pays less than $100 per session, it's easy to understand how these patients find it almost impossible to obtain an appointment.

Even with healthcare insurance, some stipulations do not benefit the patient. Authorizing 7 to 10 sessions may be adequate for a few patients, but patients usually require 20 or more sessions. This reminds me of the belief of Social Security disability consultants that persons with strokes only require six months of rehabilitation when the research shows they usually need at least one year. I suspect the same thinking is going on with mental healthcare insurance reimbursement.

When I was seeing patients, some would inform me that the insurance would only cover treatment after a specific number of sessions if the patient admitted themselves to a psychiatric hospital ward. What would you suppose they would do when someone doesn't have a diagnosis that calls for hospitalization? Of course, the insurance cut them off and refused to pay for more sessions.

Outside of healthcare funding, we also need to consider two important variables: salary and the incidence of violence. Regarding salary, some mental health clinics provide inadequate salaries (about $18 an hour) for the work they expect. Also, there may be inadequate training or education about mental health disorders.

I can recall providing a training seminar to a group that had no knowledge about psychotropic medications and thought patients moved around because they wanted to. What the patients were experiencing was a side effect of their medication called akathisia.

Anyone working in healthcare today is aware of an increase in violence by patients and visitors. The media have carried horrific stories of attacks on workers at every level in hospitals and mental healthcare facilities. It doesn't matter if there are security personnel present or not because the violence persists, and it can happen at any hour of the day or night.

I once worked in a psychiatric hospital, where one administrator took her job seriously and ensured that staff treated theirs the same. At 2 AM, she would walk into a unit, and if she found staff sleeping or doing some online homework or other activity, she took action, and it didn't happen again. Once she retired, things returned to normal; nurses and physicians faced attacks, and the staff resumed sleeping on couches at night. A patient killed one nurse because she refused to give him a cigarette.

As they say, "Rome wasn't built in a day," but we have been going back and forth with a lack of adequate funding for mental healthcare for too long. Now, after a major worldwide epidemic and economic uncertainty, the numbers needing mental healthcare have grown to epic proportions. We can’t expect a knight in shining armor to come to our rescue, but we can expect government agencies to be innovative and provide sorely needed services.