I’m an American citizen with a diagnosed panic disorder and I can’t afford to properly take care of my mental health. I know that I should be in therapy and my daily intake of 10MG of Lexapro should be monitored more regularly but, in the wealthiest country in the world — a country that still treats mental health care as a luxury — it feels nearly impossible. With the stigma that still surrounds mental health care in this country, the idea of that changing anytime soon seems like a pipe dream. Especially in light of the coronavirus outbreak, which has exposed the fragility of our system and the systemic fixes needed to ensure everyone has equal access to care.
Many other countries have universal health care, countries far less wealthy than the U.S., and I’ve found myself thinking over and over: this can’t be the case for everyone around the world. Surely, some other countries must provide better — and more affordable — access to mental health care. Unfortunately, the stigma surrounding mental illness and receiving treatment for it runs deep in many parts of the world.
One country encouraging mental health awareness is Luxembourg. Throughout the nation, an educational approach known as Positive Education,brings wellbeing and achievement skills together, instead of only focusing on the latter. Positive Education has been making waves internationally for its overwhelming success.
“Building life skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health,” Luxembourg-based psychologist Joanna West said in City Savvy Luxembourg. “Positive education programmes, delivered in school, are well documented as a preventative strategy against depression and anxiety as well as supporting healthy self-esteem, emotion regulation, empathy and self-efficacy.” Schools implementing Positive Education have seen a low rate of student drop-outs and high levels of positive engagement from both students and teachers.
While Luxembourg’s movements are incredibly impressive, Germany is considered the leader in terms of mental health care practices in Europe. The German government provides “financial support for patients, access to healthcare services, help finding or staying in work, outreach programs and awareness campaigns,” reports German psychologist Dr. Eileen Wollburg on StripesEurope.com.
It’s required for all citizens and permanent residents of Germany to have health insurance with The Commonwealth Fund reporting that 86% of people choose public health insurance, under which mental health care is covered. “Inpatient and outpatient services are included in German mental health care, and general practitioners play a key role in dealing with mental health problems on a daily basis. They identify patients, diagnose and treat problems, and refer people to specialists,” said Dr. Wollburg. “If inpatient psychological treatment is required, two options exist: psychosomatic clinics — which treat depression, anxiety, obsessive-compulsive disorder (OCD), and eating disorders, for example — and psychiatric hospitals. Germany offers partial inpatient treatment to ease the transition from clinic to home. In these settings, patients spend the entire day at the clinic, but go about their everyday lives afterward and sleep at home.”
Physicians and mental health professionals working together for the good of the patient is a key piece of the mental health care puzzle. “An important principle which plays a crucial role in the creation of mental health care in other countries is integration into primary health care,” says Cynthia Catchings, LCSW-S, CFTP, Talkspace Therapist. “As a Certified Mental Health Integrative Medicine Professional, I understand the importance of not only working as a team with other professionals, but also educating the client, and their families, about the benefits of integration.”
The State of Mental Health Care In America
While many countries still struggle with opening the discussion around mental health care, the United States was ranked third for burden of mental and behavioral disorders, adjusting for population size, by the World Health Organization. According to the National Alliance on Mental Illness, 47.6 million adults (19.1%) in the United States experienced a mental illness in 2018. On top of that 11.4 million adults (4.6%) experienced a serious mental illness that year. As for young people, in 2016, 7.7 million people aged 6-17 experienced a mental health disorder.
Yet, Mental Health America reports that this year over 26 million Americans with a mental illness are still going untreated. Yes, you read that right — over half (57.2%) of adults with a mental illness aren’t receiving treatment. For youth the numbers are just as upsetting with only 28.2% of those with severe depression reporting any consistent treatment, described as seven or more visits per year.
Now don’t go thinking this lack of care is by choice. In the same report, 22.3% of adults with a mental illness were found not to have access to the treatment they need, a figure that has sadly not decreased since 2011. No or limited insurance, lack of needed treatment type availability, and an ability to cover copays and treatments are just some of the contributing factors .
How The United States Can Improve Its Mental Health Services
So, how can we take lessons from other countries to change the mental health care system in America? “There are several things that can be done in America to make healthcare more accessible, depending on where we reside, those would be improving insurance coverage, changing client’s ability to pay, or increasing mental health funding,” explains Catchings.
While access to treatment ranged from a high of 59.3% of people in Vermont to a low of 35.2% of people in California, no state had notably higher access to mental health care than another. “As a therapist providing services in person and online in different States, I can attest that the clients’ ability to pay for services varies depending on the region, but one common denominator is found everywhere, the community programs offered and the funding.” says Catchings, suggesting one big initiative that could change this: a sliding scale for payment.
This method of payment allows people at lower income brackets to pay less for their mental health care, ensuring they can afford the treatment they need. “Sliding scale services are a good example to follow,” she explains. “In the U.S. we have many mental health professionals that excel in their field. If each one of us committed to offering a few sessions based on a sliding scale to those in need, we could start creating a chain of change that would truly impact our communities.”
Catchings also strongly stresses the importance of electing officials who will prioritize mental health services. “We are all responsible to inspire more change, and that can be accomplished by choosing representatives that want to become involved this year, and every subsequent one, in mental health programs that assist the underserved,” she says.
This ties into the overarching debate happening on the national stage over universal health care in America. As is the case in Germany, mental health care needs to be included in that conversation and part of any legislation that moves forward.
When I was in school, mental illness was never discussed, a fact of life I consider to be the main reason it took me 20 years to be diagnosed with a panic disorder despite a history of crippling anxiety and panic attacks. Fortunately, there is some movement being made on this front in America. As of 2019, Today reported nine states required mental health education in schools with at least 20 states and the District of Columbia integrating it into their curriculum.
Normalizing The Conversation Around Mental Health
Regardless of where you are in the world, there is progress that can be made around normalizing mental health and the care mental health requires. We need to be the creators of change in order to transform our culture,” says Catchings, emphasizing the need for increased education about the benefits of mental health care services and the conditions themselves.
Treating mental health just like any other condition instead of stigmatizing it as an embarrassment that only happens to “other people” is critical in making this change. Anyone can be diagnosed with a mental health condition regardless of background, upbringing, income level, race, culture, or stage of life. “If every professional, family member, and person in need of mental health services was more open and honest about it, we could prevent the issues that currently affect our communities,” says Catchings. When we make these conversations happen — whether they are comfortable or not — it empowers us to ask for the treatment we deserve in America and fight until we get it.
“The stigma created by past generations still haunts some of us, but we live in a time of change, in a time where social media can help us to share more information and create trends. It is up to many of us to be the change we want to see in the world and the time is now,” Catchings says. Until mental illness is treated the same as any other physical health condition, there will never be proper access to services. We must learn from others, continue these conversations, and be honest in the pursuit of receiving the treatment we need. And the time for action, when all of our health is under strain from the COVID-19 outbreak, is now!