As rates of mental health conditions continue to rise, alarming trends within the behavioral health space threaten access to care. Underfunding, limited services, and an overburdened workforce all act as barriers to care nationwide.
Here, behavioral health experts from across the country share their thoughts on the most dangerous trends in mental healthcare today.
Editor's note: For questions or comments on this article, please contact Zoe McClain at zmcclain@beckershealthcare.com.
Question: What is the most dangerous trend in mental healthcare right now?
Jeremy Williams, RN, MHL. Director of Psychiatric Services, St. Patrick Hospital (Missoula, Mont.): The most dangerous trend in mental healthcare right now is the lack of access for child and adolescent services. Families and patients continue to be impacted by the shortage of both acute and non-acute services within their communities. Despite an increasing demand for services, the mental health infrastructure is unable to support these families with timely care.
Shannon Gordon, EdD, LCSW. Vice President of the Behavioral Health Network at WellSpan Health (York, Pa.): The most dangerous trend in mental healthcare right now is rising demand [for mental health services] coupled with workforce shortage.
Katharine Woods, MS, DO. CMO of Eleanor Slater Hospital and Rhode Island Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (Cranston, R.I.): We face a two-sided challenge – the important drive to continue de-stigmatization of mental illness (especially severe mental illness) and improve access to care while at the same time facing the detrimental movement of over-pathologizing, and over-medication, of the broad range of normal human experience. Part of truly destigmatizing mental illness also means understanding that even those without a diagnosis can face challenges that mental health professionals can help with, from grief to life transitions to all manner of helping with coping abilities. The trend away from validating and appropriately supporting people going through difficulty in a genuinely individualized way, and instead rushing automatically to a diagnostic label and an attempted pharmacological fix, is troubling.
Craig Aasved, MBA, FACHE. CEO of Shodair Children's Hospital (Helena, Mont.): The pandemic exacerbated the demand for children's mental health services. Short staffed children's hospitals are unable to meet the growing needs for children's mental services. Schools also have limited resources to deal with the growing need for mental health assistance. We are in the midst of a children’s mental health crisis.
Steven Scott, DO. Chief of Physical Medicine and Rehabilitation; Medical Director of the Polytrauma Rehabilitation Center; Medical Director of the Inpatient Pain Program at James A. Haley’s Veterans’ Hospital (Tampa, Fla.): Not having inpatient electroconvulsive therapy available for the severely mentally ill.It would be cost saving. ECT should be more available as an option to mentally ill patients — the results are good.
Hank A. Milius. President and CEO of Meridian Health Services (Muncie, Ind.): The most dangerous trend within the mental healthcare industry is the workforce shortage. Access to care is being threatened due to lack of quality providers and programs.
James P. Kelleher, MD. Medical Director of Behavioral Health at Montefiore Nyack (N.Y.) Hospital: In my opinion, the most dangerous trend in mental healthcare is the national increase in deaths of despair which tripled between 1999 and 2020. While drug-related deaths accounted for more than half of the 186,763 total, deaths due to alcohol — 49,061 — and suicide — 45,979 — also rose significantly during that time. Importantly, these numbers were up even before the pandemic.
One very helpful response to these numbers could be increased access to care. Fewer than half of U.S. counties have a practicing psychiatrist even though about one in five Americans is affected by mental illness and one in 20 has serious thoughts of suicide. Over half of adults with mental illness receive no treatment, as reported by Moscicki and the Substance Abuse and Mental Health Services Administration.
Further integration of behavioral health and primary care could be a positive step. Telehealth offers significant promise. It is important that we recognize this crisis and mobilize around it.
Jennifer Wilkerson, MHSA, FACHE. VP and Chief Strategy Officer, Sheppard Pratt (Baltimore). The mental health crisis is a critical and worsening public health emergency but is not yet being treated like one. While much of healthcare has moved into the 21st century, behavioral health is consistently left behind. Behavioral health needs are increasing across the nation — we are experiencing significant increases in depression, post-traumatic stress disorder, substance use and suicide. Moreover, people with mental illness suffer disproportionately from high levels of chronic physical health conditions and have a life expectancy about ten years shorter than that of the general population. Many people with mental health conditions receive no treatment, and access to mental health services is highly inequitable in rural communities and across racial and ethnic groups.
We are seeing an alarming trend of decreasing behavioral health services across many communities. This lack of access is driven by extreme workforce shortages and reimbursement that does not cover the costs to provide quality care. Local rules and regulation, lack of investment in infrastructure, IMD exclusions and block grants also serve as a barrier to scaling up behavioral health services in this country. As necessary investments are made to physical healthcare, we hope that direct support to behavioral health services across the nation are made a priority. Providing access to quality behavioral healthcare saves lives. We are standing at a crossroad — in a nation where we have passed mental health parity and have bipartisan support for access to mental health treatment, behavioral healthcare needs the same resolute action that’s being provided for physical healthcare.