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The responsibility for providing mental health care is falling increasingly to primary care providers. This may reflect both the treatment preferences of many Americans and the availability and affordability of health care services. Well over half of treated patients now receive some form of primary care for their mental disorder, mostly from a primary care doctor, and primary care is now the sole form of health care used by over one-third of patients with a mental disorder accessing the health care system.
As health care reform focuses on a central role for primary care in the delivery and coordination of health care services, especially for the chronically ill, it is timely to consider how mental health services could be better integrated into primary care, and how the implementation of health care reforms could optimally deliver this.
This paper considers the various issues in mental health care and suggests options for reform, highlighting those that are facilitated by the provisions of the Patient Protection and Affordable Care Act, or ACA. The principal focus is on the role of primary care in the delivery of mental health care services and how this can be improved.
The key issues considered are:
- Mental health workforce shortages and maldistribution problems
- The ability of the primary care workforce to diagnose and treat mental health disorders
- Lack of financial incentives for primary care providers to deliver quality mental health care
- Insurance and financial barriers for patients seeking treatment for mental health disorders
- Patients’ perceptions and fears that are barriers to accessing effective and appropriate treatments for mental health disorders
- The quality of mental health services
- Comorbidities of mental health disorders with physical illness and substance abuse
- The need for early diagnosis and intervention
- Racial and ethnic disparities in mental health services
- The structure of the health care system as an impediment to the integration of mental health services
Alignment of the suggestions for reforms made in this paper with health care reforms enacted in the ACA and other recent legislation such as the American Reinvestment and Recovery Act highlights that several crucial elements are missing.
The most important of these can be categorized in three broad areas:
- Protection against discrimination for people with mental illness
- Better integration of the systems for addressing mental and physical health and substance abuse
- More youth-specific services
Achieving these goals, together with robust efforts to ensure that mental health is always considered in the implementation of the ACA, would make a substantial contribution toward expanding access to mental health services, improving the physical health of people with mental illness and the mental health of people with chronic physical illnesses, and addressing current health care inequalities for people with mental health problems, especially for those who are from racial and ethnic minorities.
Lesley Russell is a Visiting Fellow at the Center for American Progress.
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