Open Minds - Barriers to Behavioral Health

It’s a Friday morning at Highland Park Family Clinic.  Rita Zeller, GraceMed’s Director of Behavioral Health is talking with a patient — we’ll call her Katy — whose left arm is in a cast.  The arm is not the condition Katy is being seen for this morning, but is an unfortunate complication of her disease.

“Obviously my drinking is out of control,” Katy readily admits. “My car is totaled; my arm is broken. Things were better for a while when I first moved here.  Then I started having some problems, and it started up again.”

Rita-Zeller-LSCSW
Rita Zeller, LSCSW

Katy has moved to Topeka to try to get a fresh start after a failed marriage. Like far too many people with substance abuse problems, however, her journey through alcoholism traces all the way back to her early teens, a fact which makes her battle now to stay sober all the more challenging.

“Studies have shown that early exposure to alcohol and other addictive substances increases the likelihood of dependence developing at an earlier age,” Zeller said.  “It’s far less than a fair fight for people at a young age to overcome the tendency to rely on alcohol or drugs as a coping mechanism, especially since adolescence is such a troubled time in life anyway.”

The rising tide of mental health issues

The problem is big and getting bigger.  The 2016 Survey on Drug Use and Health in the U. S. released by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that more than 136 million Americans age 12 and older reported using alcohol on a monthly basis.  Two out of five young adults age 18 to 25 engaged in “binge drinking” (consuming four or more drinks at the same occasion). One in 10 Americans reported they were involved in illicit drug use, with a higher rate (one in four) for young adults age 18 to 25.

Of course, substance abuse isn’t the only behavioral health issue on the rise today. The same survey also found that 44.7 million adults age 18 and older in the U. S. reported having a mental illness within the past year, with 10.4 million having a serious mental illness (SMI).

Jeffery Hubbell, Behavioral Health Consultant
Jeffery Hubbell, Behavioral Health Consultant

“Mental health is getting more attention these days, most notably because of its association with acts of violence in the news,” said Jeffrey Hubbell, Behavioral Health Consultant at GraceMed’s ComCare Clinic. “But just as addictions are not present with all behavioral health conditions, neither, of course is violence.  The roots of mental health problems and the way they affect us are as diverse as the individuals who are diagnosed with them.”

For Katy, the roots may extend even further back than her troubled teens. Her father had to overcome his own alcoholism, one of a number of behavioral health problems that can be passed down to children.

“Children can often be the overlooked collateral damage of mental illness,” Zeller said. “In some cases, there can be a genetic predisposition to develop the conditions our parents suffer from.  In others, the behaviors our parents model for us are unfortunately implanted as legacies we don’t mean to leave to our children.”

Roadblocks on the way to help

There is, however, one complicating factor that is common for the majority of people who suffer with a mental health condition: the difficulties involved in accessing care.  The problem is at least three-fold: the scarcity of providers and facilities to provide care, the social stigma still associated with those seeking care and the cost of treatment to patients.

As a geographically rural state, Kansas has only 22 of 105 total counties that the Governor has designated as having an adequate number of mental health professionals. Only 18 counties were assessed to have an adequate number of primary care medical care professionals to meet the needs of Kansas residents.  According to the 2014 Kansas Health Institute Report “Understanding the Mental Health System in Kansas,” the deficit is even more dire.  By their analysis, only the five counties with the largest cities in Kansas are adequately supported with mental health providers.

The prognosis for solving the problem is not exactly promising either. Projections for supply and demand of behavioral health professionals for 2016-2030 by the U. S. Department of Health & Human Services / HRSA describe shortages of at least 180 adult psychiatrists, 40 pediatric psychiatrists, 60 psychiatric nurse practitioners, 300 clinical counseling and school psychologists, and more than 1,000 mental health counselors.

The good news is that federal funding is being increased to help communities address the rising need for treatment.  The 2018 federal budget included an additional $306 million for treatment of substance abuse and mental healthcare.  In 2019 fresh funding is expected for educational institutions and degree programs that specifically address the need to expand the workforce in behavioral health.

The downward spiral of stigma

There is another roadblock to care, however, that has nothing to do with the shortage of providers.  The fact is that mental health issues have always been surrounded by a stigma that makes admitting you need help very hard to do.  “There are a lot of misconceptions people have about what it means to have a mental health problem,” Rita said. “Those misconceptions lead to stereotypes and prejudices that leave people who suffer with these conditions with the added burden of coping with the disapproval of those around them.”

In a sense, they are caught in a self-fulfilling prophecy.  The discriminatory attitudes of those around them can lead to social isolation. Finding and holding a job gets difficult as does maintaining relationships. “Depression, anxiety, and many behavioral disorders are quite treatable, just like a physical condition,” Hubble said. “Unfortunately, our notions about what it means to have a mental illness are so disapproving, no one wants to be seen as needing help. The downside is we create the social outcasts we imagine these people to be when they’re really just people with a treatable illness.”

Integrating primary, behavioral and spiritual care

Dr. Julie Elder, Chief Medical Officer
Dr. Julie Elder, Chief Medical Officer

What can clinicians do to help patients overcome this hurdle to care? GraceMed subscribes to a model for treatment that is growing in acceptance in which behavioral health care is integrated with primary healthcare.  A patient who needs to be seen by a behavioral health consultant can then be referred seamlessly in the same clinical setting, avoiding exposure involved in having to go to a separate treatment center.

“When primary care providers have access to the services of behavioral health professionals right in the same clinical environment, we can help capture more people who need help,” said Dr. Julie Elder, GraceMed Chief Medical Officer. “We also benefit from consulting with professionals like Jeff and Rita to correctly identify behavioral health problems that might otherwise be diagnosed and treated as medical conditions.”

What made the most difference for Katy was trust.  “Just admitting that I needed help was hard. I had ego on one shoulder and pride on the other.  So finding someone I could trust was so important, and I found that at GraceMed. The counseling I’ve received has helped me get more comfortable in my own skin.  I’m getting to know who I am. And that’s why I come here.”

Chaplain Clarence Newton
Chaplain Clarence Newton

For those who would like to receive it, spiritual care is also available at GraceMed.  When Katy came to our Highland Park Clinic, she also met with Chaplain Clarence Newton and quickly decided to seek his counsel as well.

“When I went home after our first meeting, I just felt this calmness in my heart that I could do this because he was going to be there for me.  Pastor C helped me find the patience to follow God’s path and do it His way.”

Rita has one more question for Katy.  “What would you say to the 14-year-old  you used to be?” She thought for a long minute.  “Be honest with yourself about who you are.  When you find yourself in trouble, don’t wait. Reach out for help.”