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One obstacle preventing Americans suffering from mental illness from obtaining the treatment they need is a stigma associated with having a sullied bill of mental health.
States can overcome this obstacle in part by expanding digital access to mental health care providers. This would allow patients to obtain preventive and maintenance mental health care from the convenience and comfort of their homes.
The stigma surrounding mental health problems is prevalent on a webpage hosted by the educational nonprofit group Mental Health America aggregating social media posts with the hashtag #mentalillnessfeelslike.
“The struggle of having illness is speaking up about what is affecting you,” Alondra Sanchez posted on May 18. “The want to tell people but yet to hide it is suffocating.”
“Shame prevents people from reaching out for support,” Cara Wykowski posted to the site via Twitter the same day. “You are not alone!”
Indeed, mental health patients are not alone. Approximately 61.5 million Americans, or one out of four adults, experience mental illness in a given year, and 13.6 million, or one out of 17, suffer from schizophrenia, major depression, bipolar disorder, or another serious mental illness, according to the National Alliance on Mental Illness (NAMI).
The ubiquity of mentally ill patients notwithstanding, only “60 percent of adults, and almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year,” according to NAMI.
It is reasonable to attribute some of this lack of treatment, directly or indirectly, to stigma associated with mental illness. “Stigma can result in lower prioritization for public resources allocated to mental health services and poorer quality of care delivered to people with mental illness,” states a 2012 study coauthored by the Centers for Disease Control and Prevention and other organizations.
If mental illness stigma leads to decreased access and quality of mental health care, expanding telemental health opportunities and increasing patient access to high-quality mental health care providers could reduce the felt effects of this stigma.
Successfully treating patients with mental illnesses often requires patients to take prescribed medications consistently. Regular visits with a psychiatrist, psychologist, or other certified counselor are also commonly called for. Neither of these treatment components derives its inherent value from the patient and counselor’s physical presence in the same room.
Although on-site presence with one’s mental health care provider all or some of the time may be the best form of treatment for some patients, other patients would benefit from being able to access their providers’ expertise through audio/visual teleconferencing and obtain certain prescriptions, or at least prescription renewals, as a result of a digital doctor appointment.
Making telehealth and telemental health treatment so widespread that they are commonplace for qualified patients would result in more consistent care. It could also reduce the incidence of communication breakdowns between providers and their mentally ill patients, such as Molly Cornelius (@MollyMandlin) of The Bronx, New York, was experiencing on May 16, according to her tweet:
“Miserable. Out of 4 meds. Dr. Completely incommunicado. Withdrawl [sic] from medicine that treats both #fibromyalgia pain & #depression. So sick.”
Although not strictly a mental illness – unlike depression, which Cornelius also mentioned – fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, and memory and mood complications, according to an October 1, 2015 post by Mayo Clinic staff.
Cornelius’ tweet was reposted to Mental Health America’s dedicated site the same day by a sympathizer who chose to remain anonymous when he or she replied, “#mentalillnessfeelslike your safety net is made of wet toilet paper.”
No one can guess the backstory behind Cornelius running out of medication, being unable to reach her doctor, or resonating with a fellow patient experiencing mental illness. Nevertheless, lawmakers can improve upon “wet toilet paper” safety nets in their states by ensuring policy environments conducive to the growth of telehealth and telemental health services.
Twenty-eight states plus Washington, DC have enacted full parity laws, which require private insurers to cover telemedicine-provided services comparable to services offered by in-person providers, according to a report by the American Telemedicine Association (ATA) published in January 2016.
States should not necessarily require private insurers to cover telehealth or telemental health services, a decision best left to competitive markets. The Affordable Care Act (ACA) has amply demonstrated that insurance costs rise when governments mandate private insurers to provide care beyond what they can afford.
Nevertheless, only 22 states plus DC of the 28 states earned “A” ratings from ATA indicating parity laws authorizing statewide coverage without provider or technology restrictions. This means six of the states with parity laws either restrict private insurers from reimbursing providers for telehealth or telemental health services, or restrict providers from treating patients through telehealth. An additional 22 states either lack parity laws or have “numerous artificial barriers to parity,” the ATA report states.
Individuals with mental illness have less of an incentive to make room in their everyday lives for consistent treatment by an in-person provider if doing so mires them in stigma. Although mental telehealth treatment seems a natural alternative, providers have less of an incentive to treat mentally ill patients remotely if the insured’s plan does not extend to telehealth coverage.
Lawmakers should make sure their state laws ensure a free market in which providers and insurers can multiply telehealth and telemental health treatment options for patients.