The editorial board writes that mental health should be treated like any other illness, including when covered by insurance.


Despite all the progress and years spent improving our understanding in helping people suffering from mental health problems, one persistent challenge is the lack of access to mental health treatment. People’s perceptions haven’t evolved enough. From the days of sanatoriums and straitjacket.

“There is a tremendous amount of stigma,” said Dr. Mark H. Rappaport, CEO of the Huntsman Institute for Mental Health. “For some reason there is a belief that brain disease is a disease of the person’s character or weakness of character. If it is a biological disease like heart disease, lung disease, or any other disease, is.”

Evidence for this is how our healthcare system deals with mental health issues differently compared to other illnesses.

If you feel unwell, you will likely make an appointment with a doctor or visit an emergency care clinic affiliated with your insurance plan’s network, or worse, an emergency room. They are treated for their problem, hospitalized if it is serious enough, and then referred to a specialist.

Insurance companies will pay all or part of the claim if the patient has insurance, depending on how well the patient is covered by employer, Medicaid, or other means. It’s not a perfect system, but it’s the system we have.

When someone has a mental health emergency, such as anxiety or depression, the chain of events isn’t exactly the same, experts say.

“We’ve come a long way in the last few years…especially in the area of ​​crisis management services,” said Rep. Steve Eliasson (R, Sandy), who works by day as senior financial director at the University of Utah Hospital. rice field. clinic. One positive development in Utah, he said, is the SafeUT app that students and parents can install on their phones, giving them instant access to qualified counselors who can talk to them for free anytime.

Things get even tougher once the emergency is over, and it depends a lot on where people get insurance.

Eliasson said people with insurance accepted at Utah medical facilities are more likely to visit the UU Hospital emergency department if they live in Salt Lake City. After you’re done there, if you’re being treated for a mental health crisis, you’ll likely be sent to the U.S.-affiliated Huntsman Institute of Mental Health for inpatient treatment. But if you’re on another insurance plan, you’ll start at a hospital in the network and, if necessary, go to a smaller psychiatric ward at another hospital in the network, Eliasson added. rice field.

“Some insurers are now refusing to work with us,” Rapaport said. He said some companies “are working very hard to keep their customers within their healthcare system.” (Rappaport didn’t name names, but he expects to build bridges with these providers.)

Getting a psychiatric referral can be a battle, Eliasson said. If you look for a psychiatrist in your network, you will often find that the doctor is not accepting new patients. And if someone has to leave the network, the costs skyrocket.

Part of the difficulty in finding a psychiatrist, Rapaport said, is that insurance companies reimburse psychiatrists at lower rates than doctors who specialize in other areas. “When it comes to reimbursement rates for these services and other medical specialties, the difference is just staggering,” he says.

Eliasson said some psychiatrists and therapists in Utah and nationwide have become fed up with bureaucracy and insurance companies’ refusal to pay, and have turned to cash-only private practice.

The COVID-19 pandemic has exacerbated the problem of mental health care in many ways, Eliasson said. As the pandemic began, hospitals turned psychiatric wards into COVID-19 emergency wards and closed beds due to staffing issues. Now that the pandemic state of emergency has been lifted, “many of those beds have not been reverted to their original purpose for the mentally ill.” [needing in-patient mental health treatment]said Eliasson. “And those beds were in short supply before the pandemic.”

Meanwhile, the pandemic has also raised people’s anxiety levels. “There is probably not a single American who hasn’t experienced some kind of mental health problem during the pandemic,” Eliasson said. , or the fear of losing your job. “

The statistics on mental health in America are alarming.

A Gallup poll released this month found that depression in the United States has reached new highs. About 29% of Americans reported having been told by a doctor or nurse that they had depression at some point in their lives, and 17.8% said they currently have depression or are undergoing treatment. Both are the highest percentages since the Gallup poll began. I asked the question in 2015.

Utah does not perform very well in the national rankings for mental health care. Among the 50 states and the District of Columbia, Utah ranks 46th and 6th from the bottom for the number of adults with the highest prevalence of mental illness and low access to care, according to the nonprofit Mental Health America. Ranked. (Utah and its neighbors Arizona, Colorado, Idaho, Nevada, and Wyoming are all in the bottom ten.)

A similar ranking for children by Mental Health America puts Utah ahead, ranking 30th in the nation.

According to the U.S. Centers for Disease Control and Prevention, Utah will have 643 suicide deaths in 2021, a rate of 20.1 per 100,000 people in the state, placing it 14th nationally. The CDC listed suicide as the ninth leading cause of death in Utah that year.

Rappaport said it doesn’t make much sense to compare Utah to other states when it comes to the cost of treating mental health problems.

“In terms of equivalence of mental health care in this country, as long as we have a service remuneration model, it doesn’t get any better,” Rapaport said. Caring for people with brain disease is more important than heart disease, diabetes, or high blood pressure. “

Eliasson cited research from the University of Utah Chem C. Gardner Institute for Policy Studies that shows how getting comprehensive health insurance is getting harder. He has only one data point in this study. Only 3% of health plans sold in Utah in 2007 were “highly deductible.” This meant that patients paid more upfront and out-of-pocket for their treatment. In 2020, 38% of health plans sold here were “highly deductible.”

Insurance companies can also be, as the saying goes, “every penny smarter, every penny stupider.”

“We are establishing a crisis center to ensure that people with mental illness have a dignified and appropriate place to receive care,” Rapaport said. “But we have to go to the insurance company and negotiate with them. A reasonable rate for crisis management services is lower than what it would cost to send the same patient to a general hospital emergency room. said.”

Insufficient funds for mental health treatment by other means. Rappaport said anxiety disorders cause more than $4 billion in lost jobs and wages annually nationwide.

“We are less productive one week out of every month,” he said.

Eliasson said transparency in healthcare pricing would go a long way in pointing to, and possibly closing, disparities in claims payments. He said he is working on a bill to address this and may be ready to introduce the bill during the 2024 Utah legislature.

“From an access standpoint, transparency about ‘do you get what you pay for’ is very important,” Eliasson said. “[Patients] You need to give them that information so they can make the best choice. “

Transparency can also encourage providers to cut costs. For example, a petrol station owner who sees that the petrol station across the street has lowered its prices by a penny, must also lower its prices by a penny. When it comes to healthcare, the pennies pile up.

There is much more to be done. Hospitals need to commit more beds and resources. Insurers need to put mental health providers on an equal footing with other professionals. And both groups need to find ways to reduce the cost and disruption of getting treatment.

Mental health underlies many other challenges, including homelessness, substance abuse, education, prisons, care for the elderly, and treatment for veterans. If we solve our mental health care challenges, Utah will go a long way toward finding solutions to those problems.

Note to Readers: Paul Huntsman, Chairman of the Board of the Salt Lake Tribune, is part of the Huntsman family who donated $150 million to launch the Huntsman Mental Health Institute in 2019.



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