Gaps in Mental Health Care Fall to Unprepared Families
Mental health prescribers are in short supply and the availability of psychiatric services seems most limited for children. This week I saw a teen just out the hospital and unable to find any child psychiatrist to continue her care. Her parents called every child psychiatry office they could find and could not get an appointment, not even for a 6-month waiting list. Instead they were told, “Sorry,” but that there was nothing available at all.
College campuses are reporting record rates of mental health crises. Counseling centers on campus are unable to provide adequate services for growing numbers of students diagnosed with serious mental illnesses. In the fall semester, I had a student at Texas A & M, a large university with an excellent counseling center, unable to receive any of his care on campus because the system has been flooded with record numbers of students beginning college with major psychiatric diagnoses. Students with simple adjustment issues can meet with an on-campus counselor, but those with serious diagnoses are sent to find treatment on their own and the community psychiatrists are overloaded with too many people already in the system.
Aging baby boomers with declining memory and mood are equally finding it difficult to get the care they need. A seventy-year-old retiree in need of case management and in-home nursing can’t even find a psychiatrist to prescribe her medication.
With such limited resources, families are left to take on much of the burden for managing mentally ill, addicted, or cognitively declining children, siblings, spouses, and parents. Families are responsible for:
1. Medical care coordination
Finding providers and then making certain they talk to one another falls to families. Families research, call, and beg for care with the few prescribers available.
2. Funding for medical care
Despite parity laws, funding for mental health services continues to be a significant burden for families. Many insurance plans fail to cover necessary services, or even when services are covered, it can be impossible to find providers who accept the plan. Families must go outside the plan they pay for and pay cash for private care.
3. Food, clothing, and shelter
Mental illnesses can rob people of their ability to function and earn income. For some, diminished functioning occurs during a period of crisis, and then when they stabilize, they can return to work or school. Others spend years or even decades unable to work. Families are left to absorb these costs.
4. Re-grouping after a crisis to return to function
Families are left to supervise the process of restoring a loved one to functional status. This can be difficult, as families are often uncertain when to support a loved one, when to hold him or her back longer, and when to push him/her to go out into the world and do more.
5. Monitoring treatment adherence and response
Many mental illnesses impair insight, resulting in sick individuals denying the importance of medication, therapy, and social services. Family members have to step in and impose care on those who need it, but may not want it.
6. Advocacy
Family members are left to fight for services they desperately need.
Training additional mental health clinicians takes years. Until we have more providers to meet to greater need, the burden on families is likely to continue. If you’re a family member supporting a loved one with a psychiatric or psychological illness, join a local organization or group for support. Contact the National Alliance on Mental Illness (NAMI) for support and advocacy organizations in your community.