Mind Matters
By Alissa Zuellig

Cost, stigma, disparity and fragmentation of services are some of the barriers preventing many from seeking help. For minorities, access to care is further complicated by mistrust, fear of treatment and differences in language and communication.
Perhaps the key issue in access to mental health care is cost. Mental health care is expensive. Recent data estimates show that more than 8 percent of the nation’s total health spending is on mental health services and treatment, including substance abuse. With 42.1 million of Americans uninsured, mental health care without insurance coverage is virtually prohibitive. But for the insured, coverage is not guaranteed. It is the hope that health parity legislation will help by requiring the same health insurance coverage for mental disorders as other medical
disorders. To date, 34 states have adopted some form of mental health parity legislation. Dr. Jennifer Havens, director of Clinical and Community Services and a child and adolescent psychiatrist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian, is a supporter of mental health parity. She explains that access to mental health services is often most difficult for the American middle-class working person.
“Economically poor persons can access the mental health system, although often fragmented in care, through Medicaid,” she says. “But a middle-class person often finds themselves somewhere in the middle without care.” Due to their income level, they do not qualify for Medicaid. And if they are insured, their insurance may only cover some, or at times none, of the cost associated with treatment. Most middle-class people cannot afford these out-of-pocket fees and go without the care they greatly need.
What is encouraging, however, is the improvement in public awareness and acceptance of mental disorders as diseases thanks in part to several decades of public awareness and community outreach programs. Havens has noticed this in her own practice, particularly among her Hispanic patients. She notes that “once Hispanics understand that their symptoms are actually a manifestation of a disease process, many will use the services available to them for treatment.”
More difficult, she notes, is individual ability to perceive symptoms before seeking treatment. She explains that in chronic disorders such as depression and anxiety disorders, people cannot separate their identity and personality from their symptoms, nor themselves from their illness. For example, they may see themselves as “melancholic” or “sad” when really they are depressed. And because of the insidious nature of these diseases, friends and family might consider their loved one to be “unhappy,” “anxious” or “difficult to live with.”
Often family and friends are the first line of diagnosis in mental health. Changes in your or your loved one’s behavior might indicate a mental illness that could be largely improved with treatment. Seek help if you or a family member have a mental health problem or suspect symptoms of a mental disorder. Primary care doctors are trained in diagnosing and treating many mental disorders and can refer to therapists, psychiatrists and community resources. Mental illnesses are real and disabling diseases with effective treatments available to help those affected lead normal and productive lives.