Overworked primary care physicians are a stopgap in a national mental health crisis. It’s time for insurance companies to shoulder their fair share of the load.
America’s mental health crisis is no secret, as the majority of the country still struggles to find the necessary help. A recent study from the NORC, an independent, nonpartisan research institute at the University of Chicago, discovered that 57% of patients who requested mental health or substance misuse care between 2022 and 2023 couldn’t receive it.
Despite the federal government’s efforts to improve access to mental health treatment, investing almost $1 billion into mobile crisis teams and President Joe Biden directly calling out insurance companies for using loopholes to deny equitable mental health coverage, we're still falling short. Meanwhile, only 32% of patients reported having difficulty or an inability to receive physical health care – still too high of a number, but a 25% improvement compared to those struggling without mental health or substance use support.
Mental health and physical well-being are deeply connected, and both are equally essential for optimal wellness. Yet, the current health care system fails to provide individuals with adequate resources, placing an overwhelming amount of pressure on patients to fill in the gaps themselves and pursue next steps without proper support. Without equitable access to physical and mental health care, the system is failing those it's meant to serve: Americans spend more on health care than other high-income countries, yet we live shorter, less healthy lives.
Currently, more than 160 million Americans live in areas lacking the essential mental health providers and resources to meet patients’ needs. Primary care physicians (PCPs) have had to bridge this gap to care for struggling patients as stand-in behavioral health care professionals; up to 90% of patients with mental health issues are being managed by a family doctor, internist, or pediatrician rather than a licensed psychiatrist or mental health professional. This dynamic places additional responsibility on primary care physicians already experiencing burnout.
Even more alarming: PCPs aren’t always equipped with the proper tools to deal with complex mental health issues and may not be familiar with best practices for mental health medication dosage recommendations or tapering guidelines. Temporarily filling in the gaps may help clients avoid crises, but ideally, primary care physicians should familiarize themselves with properly licensed mental health care professionals and facilities. Referring patients for ongoing management and improved care, such as emerging treatment providers and behavioral health care specialists, can ensure that patients have the proper support and better access to lifesaving interventions.
The issue with inequitable mental health care access is not just a matter of finding the right professional. Insurance companies compound the growing disconnect by providing less coverage for mental health issues than physical health conditions, furthering the stigma and incorrect narrative that mental health issues are not as serious as physical health conditions.
Despite President Biden’s call for increased mental health insurance coverage, 87% of the population living with mental illness still feels like they are “victims of stigma,” a sentiment elevated by insurance providers’ unwillingness to cover patients’ behavioral health needs.
This disparity is further demonstrated by the same NORC study, revealing that 52% of patients who sought mental health or substance misuse care ended up being denied coverage three or more times by their insurance provider, whereas only 33% of patients experienced this denial of physical care. Furthermore, 80% of patients were required to resort to an out-of-network provider for mental health or substance misuse care, while only 6% of patients experienced this barrier in accessing physical health resources. If insurance providers properly reimbursed behavioral health providers for value-based care, more treatment centers and clinicians could afford to go in-network and expand their reach to patients who need support.
While perhaps the most systemic changes start with health insurance companies following mental health parity laws, primary care physicians can also reduce the stigma by communicating the correlations between patients’ physical and mental health. The two are inherently connected, so all providers and health care companies should treat them as such – providing for immediate needs, educating patients on their options, and referring them to the proper specialists. By incorporating this mindset, providers can help evaluate a patient’s overall health for more comprehensive care.
Health care companies can also support physical and mental health by offering more integrated care coverage. It’s possible a patient's behavioral health symptoms might stem from a dire physical condition or vice versa, and identifying the connection can help address the root issues of dysfunction. We've seen this firsthand: An APN patient believed his fatigue to be the result of depression, but our in-house medical providers ordered labs and discovered unusually low iron levels. This due diligence led to a hematologist referral, where he was diagnosed with non-Hodgkin’s Lymphoma. Mental health and physical health symptoms have so much potential for overlap that it’s frankly irresponsible to dismiss one in favor of the other.
By offering access to licensed mental health professionals and therapy in tandem with in-house labs and GP services, health care companies can address patients’ needs beyond traditional primary care offices, assisting both mind and body.
In addition to offering mental and behavioral health resources, health care companies can further support patients by utilizing evidence-based emerging modalities proven to help with mental illness and addiction, such as deep transcranial magnetic stimulations and ketamine-assisted therapy, and partner with fitness centers that emphasize overall wellness and social community. We can't solve the national physician shortage overnight, but insurance companies and medical providers can take action by connecting patients with additional treatments and resources.
Insurance companies chip away at America’s already urgent shortage of available mental health resources and care by flat-out refusing to cover essential behavioral health services and under-reimbursing providers for their work with patients. We can't wait for lawmakers to tackle the issues: Physicians and health care companies must recognize their duty to their patients and help bridge the gaps by adopting more holistic approaches to care. Otherwise, their patients pay the consequences.
Noah Nordheimer is founder and CEO of APN, All Points North, a mind-body health company based in Edwards, Colorado.