The implementation of the Affordable Care Act helped to ensure that mental and behavioral health treatment would be an essential benefit covered by health insurance policies sold on the federal health exchange. It was a measure that drastically expanded access to mental health treatment for a number of Americans who may have previously been denied or lacked funds to seek help for a variety of mental health problems.
Although access has been expanded greatly, many people still struggle to access mental health treatment. For some, lack of treatment can be attributed to the lingering stigmas surrounding mental illness or the cost of treatment. Many others, however, choose to forego treatment simply because there are no mental health practitioners in their communities.
“Right to care does not mean access to treatment,” Columbia University Psychologist Paul Appelbaum said in an interview with The Guardian. “Tens of millions of people who did not have insurance coverage may now be prompted to seek mental health treatment, and the capacity just isn’t there to treat them.”
It’s a concern that has plagued counselors, social workers, and other healthcare professionals for years. In rural areas especially, a lack of qualified counselors means that people simply don’t have access to mental health treatment.
Professor Goutham Menon, who directs the Social Work Program at the University of Nevada, Reno, attributes this problem to the rural area “brain drain,” which occurs when students from rural communities attend college and don’t return to their hometowns, opting instead to live in more metropolitan environments.
Naturally, this leaves a gap of coverage in small towns, where people may not be able to access a mental health professional without traveling long distances. In rural Texas, for example, 185 out of 254 counties have no psychiatrist, which means that 3.2 million people may not have access to psychological care.
The story is all too similar in other parts of the country, and the consequences for lack of treatment go far beyond the individual.
First and foremost, mental health and physical health are inextricably connected, meaning that as these individuals forego mental health care, they’re also getting sicker. This puts many individuals at a higher risk for chronic conditions, which, according to the CDC, are the leading cause of death and disability in the United States.
Furthermore, those who struggle with mental health disorders have a far higher probability of becoming entangled in the criminal justice system.
“Where we don’t have those services for mental health patients, they wind up cycling back through our jails and our emergency rooms,” Texas state Senator Charles Schwertner tells NPR.
The problem is hardly secluded to rural Texas. Reports of overcrowded county jails and thinly stretched government resources exist in places all over the United States. As a result, many communities experience similar cycles of dealing with mental illness: starting with hospital emergency departments and ending with law enforcement.
“In a small rural area, you might not have access to a hospital, especially a hospital that has a behavioral health worker,” Paul Mackie of the National Rural Mental Health Association says. “So law enforcement is the de facto response to mental health issues in rural America.”
Access to mental health coverage is a major concern for local governments throughout the United States. Although there is a major shortage of psychiatrists overall in the medical field, many lawmakers have begun to put forth measures that they hope will solve the crisis before it gets much worse.
For some states, attracting psychiatrists to the area through loan repayment programs has been successful. These programs help medical professionals pay off their loans if they choose to serve in underprivileged areas for a certain amount of time. But others think these policies are shortsighted at best.
“The most successful strategies are to find young people within the rural community,” Sita Diehl of the National Alliance on Mental Illness tells NPR. “They know the community, they have an investment in the community. Otherwise the turnover rates in these loan repayment programs are pretty high.”
By investing in the people who are already a part of the community, she argues, that will stop medical professionals from leaving once their loans are paid off.
Others argue that by equipping mental health providers with technology, patients in rural states will have better access to care.
“Technology has the potential to decrease the gap in services and improve education, support, and connected between the client and the provider,” a University of Virginia study notes. “As an alternative to traditional face-to-face contact for those in rural and geographically dispersed areas, the internet potentially can bridge the disparities in health care access for rural mental health services.”