Roughly two-thirds of Americans with a diagnosed mental health condition were unable to access treatment in 2021, though they had health insurance. And only a third of insured people who visited an emergency department or hospital during a mental health crisis, received follow-up care within a month of being discharged.
These are among the findings of a new report by the actuary firm Milliman, released Wednesday. The mental health advocacy group, Inseparable, commissioned the report and also released an accompanying brief offering policy solutions to address the gaps in mental health care.
“We kept hearing nightmare stories about Americans not getting the treatment that they needed because insurance companies were denying them care,” says Bill Smith, founder of Inseparable. “But we didn’t have enough data to show just how extensive and deep the problem was.”
I couldn’t agree more with everything you’ve said.
I was an caseworker for the adult population with serious mental illness (SMI) and was on a specialized team working exclusively with individuals whose SMI was severe enough that they were unable to live independently. All of my clients lived in various residential care or assisted living facilities in my region. A big part of my job was teaching daily living abilities and working to reintegrate people into independent living in the community (or often a semi-indepent housing facilities with more freedom to take steps).
Covid was a substantial disrupter, cost of living is out of control, housing is completely unaffordable, and before covid + RSV + pneumonia kicked my ass out of my job, all of the housing programs in my region were totally backed up. A former team member told me recently that the housing programs all basically are at a standstill.
The population I worked with typically were not their own guardians. Most had court-appointed guardians (typically the county public administrator, because family usually was non-existent, inappropriate, or unwilling) due to repeated hospitalizations and arrests (often behavior from drugs, alcohol, or psychotic episodes). Some absolutely needed guardians due to level of function, others were capable of governing themselves, but trapped under a guardian.
The thing most of my clients had in common was being homeless at some point. That’s often what signified the start of their substance use and most severe period of SMI. It’s very common for people to develop substance use when living on the streets due to the widespread use in the homeless community. They are simply comforting to the group that typically is their only source of support.
Since deinstitutionalization, the Department of Corrections (DOC) has been the largest mental health provider, and the situation is a revolving door. By that, I mean people are arrested due to crisis, substance use, psychotic episodes, etc.; receive medications and become stable; are released on the streets without adequate support/stable housing; can’t/don’t refill their medications; often fall back into substance use because of prevalence among peer-support; have a relapse of symptoms, experience a crisis, or have psychotic episode or drug-induced psychosis; and finally they are arrested again. Rinse and repeat. That is how most of my clients ended up under guardianship.
We must have our basic needs of safety and shelter met if we are to be able to live stable within society. The homeless population’s basic human needs aren’t being met. They are a massive and growing marginalized society in the US. We must have affordable housing and rent or the problem will just continue cascade.
Edit: Worth noting I also have ADHD and I’m slightly medicated from vaping… Makes me rant…