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Richard Shelton, MD

What Does Being Last In Mental Health Providers Cost Alabama?

Every other state--and the District of Columbia--has more mental health care providers per capita than Alabama.

Beyond the financial and distance limitations on access to mental health care, the lack of trained professionals is hurting the people who need help they aren't getting--and all the lives that their lives touch.

Emotional turmoil and abuse in families, interpersonal stress in the workplace, and even road rage endangering strangers on the highway are only some of the collateral damage that can happen when access to mental health services is limited.

"We are all connected and play different roles in different circles," clinical psychologist DeLisa West, PhD, of West Neuropsychology, said. "When mental health needs aren't addressed, the effect is like ripples that touch many lives."

Richard Shelton, MD, UAB professor of psychiatry, said "We know that when parents are depressed, their depression affects their families. Children may have conduct problems or develop emotional difficulties. When we treat the parent's depression, the children also get better."

With only one mental health provider per 1260 people, Alabama is in last place, but it definitely isn't alone. According to Mental Health America data, 56 percent of American adults with a mental illness do not receive treatment.

What happens to these people and those around them? Untreated mental conditions affect physical health. Much of the bad news we hear every day can be traced back to a time when intervention and emotional support might have prevented the drug dependency, violence, bullying and the horrific shootings we are seeing in schools and workplaces.

Many people manage to muddle through, missing out on the happiness they might have had, and passing along the second hand stress. Some leave families grieving for lives cut short or diminished by alcohol, aimlessness and an inability to form meaningful relationships.

To see where all too many cases of untreated mental illness lead, look at America's prison systems and incarceration rates compared to the rest of the world.

The National Alliance on Mental Illness reports that two million people with mental illness are booked into jails each year. Nearly 15 percent of men and 30 percent of women in jail have a serious mental health condition. The Washington Post reported that a Treatment Advocacy Center survey found that in 44 of the 50 states, the largest prison held more people with serious mental illness than the largest state psychiatric hospital.

Compared to the cost of taxpayer-funded prisons, mental health services are a bargain. There is still, however, the barrier of a lack of trained people to provide those services. In specialties like neuropsychology, the shortage is particularly acute.

"There are so few of us to assess deficits due to neurological conditions like Alzheimer's, head injuries and strokes," West said. "A neuropsychology assessment is very different than a typical doctor's appointment. It can take hours or most of the day, depending on the complexity of the case. Getting an appointment may take a while.

"We need to encourage more people to go into the field and to practice in underserved areas where they are so very much needed."

The laws of supply and demand would suggest that where there is a high unmet demand for more mental health providers, we should be seeing more of them. Why is there such a serious shortage? The answer may be found in the differences between how mental health services are reimbursed and how physical health services are reimbursed. How many job openings will current reimbursement policies fund?

A professor of psychiatry at UAB, Shelton said, "We are training the next generation of mental health providers. When medical students consider whether to go into this specialty and where to practice, they have to think about where the career opportunities are."

As the value of healing the mind begins to be seen in a similar light to healing the body, perhaps broader reimbursement policies will open up new opportunities for more mental health providers to build careers--and rebuild lives.

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DeLisa West PHD, Mental Health Services, Richard Shelton MD, UAB West Neuropsychology LLC

 

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