How Mental Healthcare Access Can Improve to Meet Patient Needs

Challenges, limitations in primary care

Four in 10 mental health visits happen in a primary care setting, the AfPA report noted, potentially because of the longitudinal relationships patients have with their primary care provider. Primary care providers have had the opportunity to build a strong baseline of trust with patients, and that trust may make it easier for patients to disclose mental healthcare needs.

But primary care providers often find themselves unable to address mental illness fully, the report added.

Foremost, their training limits their ability to treat patients with mental illness. While many primary care providers are equipped to treat illnesses like substance use disorder and other mental health comorbidities like obesity or diabetes, they do not have the tools to address the mental illness that is the root cause of those comorbidities.

Healthcare policymakers may consider mechanisms to improve continuing medical education focused on mental healthcare. Fellowship work could allow primary care providers to learn how to identify and treat patients displaying signs of mental illness, the researchers advised.

The researchers added that primary care providers do not have the time to address mental health concerns during care encounters that already feel too short. The length of a typical primary care visit (around 8 or 12 minutes) is shorter than a psychiatric visit, and they are more sporadic than psychiatric visits, the report noted.

Finally, primary care providers may feel limitations in their ability to coordinate care for their patients. When a primary care provider does want to refer a patient to a psychiatric health provider, they cannot always make an appropriate connection.

“Specialists are many miles or hours away, making in-person visits difficult. For patients with limited access to telemedicine, geographical hurdles are often an insurmountable barrier to care,” the researchers explained.

Cultivating a wider network of mental healthcare providers, as well as making televisits for mental health needs more plentiful, will be critical to helping primary care providers make those necessary referrals.

Challenges, limitations in emergency departments

Many patients end up in the emergency department because of a mental health emergency, like an instance of self-harm. Citing figures from the Centers for Disease Control and Prevention (CDC), 312,000 of the annual ED admissions are cases of self-harm.

That means some level of mental healthcare is initiated within the ED, the researchers said, but EDs don’t have the tools to appropriately begin that work.

“Most emergency provider training focuses on addressing critical physical injuries and ailments, from broken bones to gunshot wounds,” the researchers explained. “There are no set requirements regarding psychiatric training for emergency providers, even though mental health patients frequently turn to emergency departments for support.”

That difference in training can have adverse consequences for all patients visiting the ED. Patients experiencing a mental health crisis may not receive the help they need and, in fact, see their condition worsen in the chaotic ED environment. Meanwhile, those with serious physical ailments may face longer ED wait times.

The report authors suggested that US healthcare needs to develop a viable mental health emergency response that is separate from physical emergency response. The 988 mental health crisis line is a good step in this direction, although it is stymied by funding issues and is not always a pathway to long-term mental healthcare, the researchers pointed out.

And while a separate mental health emergency department may help fulfill patient needs, the researchers acknowledged that the solution likely rests far into the future. Instead, they said acute care settings should have a psychiatric nurse or psychiatric nurse practitioner on staff. Additionally, policymakers should consider regulations requiring continuing education in mental health for ED staff.

Mental healthcare providers have limits, too

Getting mental healthcare from a psychiatric provider is currently the best option for patients, but the researchers emphasized that there are care access problems in these settings, too.

Patients may be discouraged from traditional mental healthcare because of any perceived stigma, cost barriers, or concerns about one-size-fits-all care, like having to complete step therapy or prior authorizations.

“Policymakers and insurance companies need to refocus on the end goal: improving the health and well-being of patients,” AfPA urged.

Bridging the access gap using telehealth will be crucial, the authors wrote, and health plans should acknowledge that by reimbursing for telehealth.

Moreover, social determinants of health interventions will help not just ameliorate external drivers of mental illness but also help patients overcome the barriers that keep them from getting mental health treatment.

Ultimately, efforts must come down to patient-centricity, the authors asserted. The healthcare industry cannot dictate how or under what circumstances a patient will need mental healthcare, so it is essential that providers can meet patients where they are and then appropriately refer patients to specialized services.

To get there, healthcare stakeholders should consider continuing medical education, stronger mental healthcare networks, and telehealth reimbursement.

“Rather than trying to define and categorize individuals into rigid models of care, policymakers and health care providers must pursue patient-centered mental health care,” the researchers concluded. “That requires giving health care providers the tools, autonomy, training and funding to address the mental health needs of patients everywhere.”