week 7 responses
response 1
Thank you for your discussion about access to mental health treatment. I agree that COVID-19 exacerbated inequalities among racial and ethnic monitories. I also learned this week how much COVID-19 exacerbated other inequalities. The need for mental health services increased during COVID-19 and during the recovery phase of the pandemic (Lyne et al., 2020). Mental health providers needed to adapt and adjust how they delivered mental health treatment due to the unique challenges posed by COVID-19 (Lyne et al., 2020). One of the methods utilized during COVID-19 was providing mental health treatment via telehealth (Summers-Gabr, 2020). However, the use of telehealth required broadband which brought to light equity issues for rural communities (Lyne et al., 2020; Summers-Gabr, 2020). Rural communities have less access to broadband, which made things like remote learning, remote working, and telehealth more difficult to access (Lyne et al., 2020; Summers-Gabr, 2020). Roughly 42 million Americans did not have access to broadband access during COVID-19, which further exacerbated inequalities for individuals living in poverty and rural areas (Summers-Gabr, 2020). I also agree that the cost of health insurance is a barrier for accessing healthcare services. Expanding Medicare and Medicaid programs would increase the number of individuals who have health insurance; however, it will not fix the problem associated with the lack of healthcare providers but instead exacerbate it. Therefore, if private and government organizations provide better coverage for health insurance, initiatives will also need to be done to secure additional healthcare professionals. Access to healthcare will remain limited even if more people have health insurance because there will not be enough providers to care for the newly insured individuals.
References
Lyne, J., Roche, E., Kamali, M., Feeney, L., Gavin, B., Lyne, J., & McNicholas, F. (2020). COVID-19 from the perspective of urban and rural general adult mental health services. Irish Journal of Psychological Medicine, 37(3), 181–186. https://doi.org/10.1017/ipm.2020.62
Summers-Gabr, N. M. (2020). Rural–urban mental health disparities in the United States during COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S222–S224. https://doi.org/10.1037/tra0000871
Response 2
Excellent post! Common barriers to mental health care access include limited availability and affordability of mental health care services, lack of education about mental illness, insufficient mental health care policies, and social stigma (Coombs, et al., 2021). As documented in “Mental Health: A Report of the Surgeon Generalâ€24 and its supplement, “Mental Health, Culture, Race and Ethnicityâ€19, racial and ethnic minorities have less access to mental health services than do whites, are less likely to receive needed care and are more likely to receive poor quality care when treated (Coombs, et al., 2021). According to reports from the National Alliance on Mental Illness (2017), nearly half of the 60 million adults and children living with mental health conditions in the United States go without any treatment. People who seek treatment must navigate a fragmented and costly system full of obstacles. As a result, many people cannot access mental health care when they need it most.
Provider discrimination, including stereotyping and bias is another source of disparities in access and utilization of mental health care in most communities. However, there is no scientific research that that have made an empirical link between bias the stereotypic belief or and actual clinical discrimination in the provision of mental health care services in the United States. When many people encounter out-of-pocket costs, it is likely to result to them seeking less care or going without any care at all. In most cases, out-of-pocket costs that exceed $200 are more common in people visiting a mental health prescriber (16%) compared with visits to medical specialists (9%) or a primary care provider (6%) (National Alliance on Mental Illness, 2017). Generally, Racial/ethnic, gender, sexual minorities, and those in the lower socioeconomic strata often suffer from poor mental health outcomes due to multiple factors, including inaccessibility to high quality mental health care services, lack of healthcare insurance, discrimination, stereotyping in the community, cultural stigma surrounding mental health care, and overall lack of awareness about mental health (Coombs, et al., 2021).
References
Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among US adults with mental health challenges: A population-based study. SSM-Population Health, 15, 100847. DOI: 10.1016/j.ssmph.2021.100847
National Alliance on Mental Illness (NAMI). (2017). The doctor is out. https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out
Response 3
Thank you for your discussion about access to mental health treatment. I learned a lot about urban California and the mental health needs within that state. I think it is great that UC Davis and UCLA schools of nursing launched an initiative to develop 300 PMHNPs in the next five years. Rural parts of the country are also dealing with provider shortages that affect access to mental health treatment. According to Summers-Gabr, several rural counties lack psychiatrists and psychologists (2020). Among rural areas, 65% are currently lacking a psychiatrists compared to 27% in metropolitan areas (Johansson et al., 2019). I agree that increasing the number of mental health providers to include PMHNPs can will improve accessibility. I currently reside in South Dakota which is a rural state that also lacks enough mental health providers to meet the mental health needs of our state. The need for mental health services increased during COVID-19 from the increase in mental health symptoms (Summers-Gabr, 2020). This exacerbated the issue with mental health providers. It is common to have to wait six weeks for an outpatient appointment and sometimes even longer if you’re in needs of substance abuse treatment. I think it would be great if South Dakota followed the same initiatives that California has put forth to increase the number of PMHNP to increase the number of mental health providers available.
References
Johansson, P., Blankenau, J., Tutsch, S. F., Brueggemann, G., Afrank, C., Lyden, E., & Khan, B. (2019). Barriers and solutions to providing mental health services in rural Nebraska. Journal of Rural Mental Health, 43(2–3), 103–107. https://doi.org/10.1037/rmh0000105.supp (Supplemental)
Summers-Gabr, N. M. (2020). Rural–urban mental health disparities in the United States during COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S222–S224. https://doi.org/10.1037/tra0000871
