Second look: The AMA prescription and good mental health

This was one of the original posts on the Hopeworks Advocacy blog that no longer exists.

In a recent publication the AMA describes the characteristics of a good health system.  It is interesting to compare these characteristics with the mental health system we currently have.

Among the characteristics they point out are:

1. An adequate supply of medical personnel to meet the needs of the people.
2. Timely access to treatment.
3. Patient choice about where they seek help.
4. Fair rules that protect the most vulnerable and allow them reasonable access to treatment.
5. Treatment that is cost effective.  Patients get the most for what they pay for.

The irony of the AMA proposal is that this is why they oppose serious health care reform proposals like the single payer plan of Physicians for a National Health Plan.  They say this kind of reform will cause the loss of the possiblility of these attributes to the health system. 

The truth is that as far as mental health  goes this is already a description of the mental health system.  We have become what the AMA says we should fear.

1. There is not anywhere near enough treatment resources.  In rural areas and small towns this is particularly true.  In most areas private practioneers have past a full case load and mental health centers have far more to cope with than they can.  24% of the adult population will suffer from a serious emotional illness.  Many of them are left to cope on their own.  The fact that our jails are full of people, who with adequate treatment wouldn’t be there, is proof of this.
2. Because of this huge waiting periods are the rule, not the exception.  If someone with heart disease was told to wait 12 weeks for an appointment he would raise an outcry.  Those with mental illness are expected to wait.  8-12 weeks can be an eternity for someone with an emotional illness.
3. Patients have little or no choice.  Very few have enough resources to be able to afford private practicioneers.  At many mental health centers they have access to psychiatrists who have little opportunity for  individual attention, who have far too big of a case load.  The therapists are normally those who don’t have the credentials or experience to maintain a private practice.  Many have no choice about even these options.  They have no insurance or are in a setting where they must rely on primary care physicians for care.   For example, it is well known and established that antidepressants are not a good choice for those with bipolar disorder.  Yet over 52% of people with bipolar disorder report being prescribed antidepressants as a first line medication.  This is because such a large part of care is provided by primary care physicians.
4. The most vulnerable parts of the mental health population do not normally have adequate resources to get care.  This is because resources are normally tied to employment and severe mental illness tends to interfere significantly with employment.  For the most vulnerable their illness interferes with their ability to get the care they need for their illness.  It is one of the most self-defeating aspects of the mental health system. 
5. Mental health is incredibly expensive.  Medication is extremely necessary and extremely expensive.  Like all other parts of the health care system the extremely high level of administrative waste drives the cost of insurance sky high.

The mental health system has many, many highly skilled providers and dedicated people.  Unfortunately the holes are huge.  There are not enough people to bail and the boat is sinking.  It is time for a new boat