Everyone would like to consider themselves emotionally healthy, and for the most part people are emotionally healthy. Even some who suffer from minor mental illnesses manage to be fully functional in society, able to hold down professional jobs, raise families and live normal lives. With treatment even those who suffer from serious mental illnesses can have lives worth living and be productive. The key is treatment, but is that treatment available to everyone on a equal basis?
Is Treatment an Option
Psychological services, like any medical treatment, is expensive. While psychiatrists may take basic health insurance coverage, often therapists and mental health programs do not. Since most psychiatry is now limited to the prescribing of medications and not with any kind of talk therapy, it's most likely that a person will see a psychiatrist for about 15 minutes per visit. They will come away with the necessary medications to keep them stable, but are meds the most productive treatment for mental illness?
Therapy is seen as basic to the healing art of mental illness. Talking is often part of treatment, yet fewer and fewer therapists, whether they be certified social workers or licensed psychologists, are taking health insurance. The cost of one 50-minute therapy session can run someone between $150 and $200. That is a lot of money. No one is suggesting that therapists aren't worth their weight in that money, but the question arises as to who can afford the treatment.
Inadequate Insurance
Many therapists refuse to take medical insurance including state and federally funded Medicaid/Medicare programs because the payment schedule is woefully outdated. These insurances often pay a scale that is still based on 1980-1990 costs. All insurances further limit the number of visits per year and many have a co-payment that can be twice what the patient pays for a visit to their medical doctor. When one examines the cost of becoming a psychiatrist, psychologist or social worker, it is no wonder that therapists are reluctant to take insurance because insurance payments often prove to be inadequate to meet office, malpractice and living expenses for the therapist.
Furthermore, those who lack any insurance are most likely unable to even pay the high prices for treatment and may settle for medication only treatments that serve to stabilize the mentally ill person but do little to enable them to get better and to heal. Those under a certain level of income but above the cut off for federal programs often have to go without even the comfort of medications that can help them cope with the mental illness they have.
Who is Served
It thus becomes clear that often the only people receiving treatment for their mental illnesses are those who can afford to pay out of pocket for what they need. For many, this is a luxury reserved only for the wealthy who can afford the high cost of therapy that is not covered by insurance. Even when therapists enact a sliding scale for their patients, some people simply cannot afford another expense in this economy.
Thus it becomes a situation where only the poor who qualify for federal programs or the wealthy who can afford to pay out of pocket for treatment are getting the services they need. Others fall through the cracks, struggling to deal with the nightmares in their minds, while unable to afford the proper treatment to be healthy.
Mental Wellness
In our health conscious society where mayors and governors preach against smoking, obesity and other health issues, few have taken the responsibility to recognize the scope of mental illness or to do anything to make the treatment of mental illness a priority. In New York City a recent ordinance requires restaurants to post caloric counts in their menus so that people can make educated decisions about what to eat. Yet, New York City has no current plan to ensure that everyone who suffers from a mental illness can access treatment.
It is thus imperative that society take seriously the suffering of the mentally ill and begin to advocate for adequate help for anyone who suffers emotional discomfort. If this is to be a healthy society then emotional health must be included in that notion of healthy living. It is time for city, state and federal government to take responsibility for all types of wellness and work toward making services available for everyone.
