A survey from the National Alliance on Mental Illness shows that for people with insurance, mental healthcare is still tougher to access than other kinds of care. There are a variety of reasons for that. Here to discuss this report is Ken Norton. He’s the executive director of NAMI New Hampshire. He spoke with NHPR’s Peter Biello.
Let’s talk about one of the major findings in this report, which is that there are too few mental health therapists. That’s one of the reasons why it’s harder to find mental healthcare. This report focused on the nation as a whole, but what about New Hampshire? Does that finding also apply to New Hampshire?
Absolutely. New Hampshire had pretty severe workforce development issues. A recent report indicated in the community mental health system alone that there were 200 vacancies, and that becomes a compounding effect, certainly. But on the private sector side also those vacancies and the institutional side like hospitals, New Hampshire hospital, tremendous workforce issues.
Essentially we’ve got a lot of open positions for mental health therapists, but not enough people to fill those positions.
Correct, and it’s really across the spectrum, as the report indicates. There’s certainly a psychiatric shortage, but also prescribers, nurse practitioners, nurses, psychiatric nurses, social workers, therapists.
Another finding of the report was that just in-network it’s difficult to find them. You might be able to find one, for example, out of network, but that doesn’t mean it’s the same, and it might mean that a patient may end up having to pay more because their provider is out of their network.
Both of those issues are very true and very problematic. And what we’ve been experiencing in New Hampshire and I think this is happening nationally as well is what I would call ghost networks. So in other words the network exist on paper, but when people call the providers to access those services, they’re told for a variety of reasons that, “Oh, we’re not talking new patients. Oh, we’re only taking older adults. Oh, we’re only taking adolescents. Oh sorry, we don’t have somebody that can prescribe that medication.” So the networks are really networks in name only. And that has become very problematic for people.
How do patients cope with that, typically?
People with means go outside of the networks and pay out of pockets. Often times it’s significant amounts of funding in order to do that because many mental health services are on-going, and people without the means to do that often go without treatment. And we know that one in five people have a serious mental illness or have a mental illness, and up to 50 percent of people are not receiving treatment for those conditions.
Which may have broader societal costs.
So going back to that first issue talking about those missing, or those open positions that haven’t been filled. What can be done about that to attract more talented mental healthcare providers?
Well, that’s a key question and it’s again very complex. It goes back to reimbursement rates for what providers are being paid for these services so that they can in then turn attract quality staff and keep quality staff. It’s also about that I think in a lot of ways we talk about the stigma or discrimination relative to people with mental health conditions or substance use disorders, and the truth is that we also, we devalue those people, and we devalue the people that work with them. So attracting younger people to these professions is more difficult. And again that’s across the spectrum, whether it’s a psychiatrist or whether it’s a mental health provider or therapists. There are licensing requirements that are very challenging. In New Hampshire there’s a lack of reciprocity with other states, and that’s created a lot of log jams in terms of people begin able to get licensed in the state.
Reciprocity meaning therapists from other states may not have the same credentials when they cross over into the granite state?
Correct. Even though they have the same credentials that the state does and provide them a license to practice in New Hampshire. And I think perhaps a more important piece for consideration to your question, and it’s a great question, is if one in five people have mental health conditions, then young people themselves and/or their family members and/or their friends have those types of issues, and how can we be attracting those people with lived experience to become mental health professionals?
This report was a national report, but was there anything in this report that surprised you or went against the New Hampshire grain?
I think here was one thing that surprised me, and that was that Medicaid recipients are better able to access services than people with private insurance or the general population. The percentage of people that had difficulty accessing services with Medicaid was slightly lower in that regard, so that was a real positive finding.
As President-Elect Donald Trump talks about making the repeal of Obamacare a priority for his administration, what are your thoughts or concerns?
Well, that’s very problematic and obviously it’s a really complex issue, but the Affordable Care Act has really paved the way for a lot of positive things regarding mental illness, and one of those is the waiver around preexisting conditions obviously, which has been hugely difficult for people with mental health conditions, and the provision that allows people up to age 26 to be covered under their parents health insurance.
Some of the major mental illness and disorders occur between ages 18 and 25, so that’s really a difficult time when people are transitioning and a key time for them to have health insurance. Unlike physical disabilities, that’s a period generally of accepted wellness for physical conditions, for mental health conditions that can be a really challenging time for young adults.