As the pandemic continues to disrupt life across the U.S., a staggering number of Americans are reaching out to their primary care doctors for help with sometimes overwhelming mental health struggles. Yet primary care doctors like us have nowhere to turn when it comes to finding mental health providers for them, and our patients often suffer without the specialty care they need.
It’s time for the American Medical Association to take decisive action and declare a national mental health emergency.
More than 40% of Americans report symptoms of anxiety or depression, and emergency rooms are flooded with patients in psychiatric crises. Untreated, these issues can have devastating consequences. In 2020, an estimated 44,800 Americans lost their lives to suicide; among children ages 10 to 14, suicide is the second leading cause of death.
Finding mental health providers for patients is an uphill climb, in part because there is no centralized process for it. Timely mental health services are astonishingly difficult to obtain even in Massachusetts, where we live and work, which has the most psychologists per capita. Waitlists for therapists can be longer than six months for adults, and even longer for children.
Knowing that our patients need urgent care, we direct them to a web-based magazine, Psychology Today, which has a directory of private practice therapists — though the information is often outdated — alongside paid advertisements.
Patients also search insurance directories, which can be so littered with inaccuracies that they have been called ghost networks. This requires patients to hunt, one phone call at a time, for an available, affordable provider who calls back — a process known to be rife with racial and class bias.
Our patients’ experiences mirror a nationwide survey by the National Alliance on Mental Illness. It found that 55% of participants contacted a psychiatrist only to learn the doctor was not accepting new patients, and 33% could not find a single mental health provider who accepted their insurance. Low reimbursement rates prevent in-network therapists from earning an adequate living, leading many mental health providers to choose private practices, where high fees put services out of reach for many.
Given these barriers to care, it is unsurprising that NAMI estimated in 2017 that “nearly half of the 60 million adults and children living with mental health conditions in the United States go without any treatment” — and that was before the pandemic, which has multiplied mental health needs.
The AMA has declared emergencies in the past. In 2016, it declared gun violence “a public health crisis” on the basis of approximately 30,000 deaths by gunshot wounds each year. In 2020, the AMA recognized that racism is a “public health threat.”
Recognizing the growing need for psychiatric care in May 2021, the CEO of Children’s Hospital Colorado declared a state of emergency for children’s mental health after emergency department visits for anxiety and depression increased 72% in one year. At the time, the hospital was experiencing a shortage of inpatient psychiatric beds and suicide risk was the leading reason for emergency department visits.
Do public emergency declarations make a difference? Measuring this is challenging. But by declaring a national mental health emergency, the AMA would shine light on this urgent problem that is exploding in the shadows of the pandemic.
Other medical professional groups want the AMA to take this action. In May, delegates from the American Academy of Pediatrics and the American Psychological Association invited the AMA to address the issue collaboratively, proposing a 10-page brief of policy and funding changes to improve access to mental health care. While about 30 health groups endorsed and committed to the work, the AMA declined, agreeing only to “encourage efforts” to increase access for children. The association did not mention the crisis befalling adults or of calling the situation what it is: a medical emergency.
By declaring a mental health emergency, the AMA could galvanize health administrators and drive the innovation needed to improve the existing mental health system. When Covid-19 was named a pandemic, the U.S. health care infrastructure adapted quickly to manage the deluge of infections. Leaders nimbly and creatively mobilized resources. They redeployed staff, built field hospitals and overflow ICUs, and deferred surgeries and routine care to preserve resources and minimize hospital-based transmission of Covid-19. With proper framing and a sense of urgency, similar things can happen for the mental health care system.
To be clear, all of this is the AMA’s lane: In addition to the devastating toll of suicides and overdoses, untreated mental illness worsens cardiac outcomes, increases mortality from Covid-19, and shortens life spans. Adult mental illness also directly affects the health of children, leading to poor health outcomes across generations.
Some solutions for the mental health care crisis may be relatively simple. A centralized website where patients could find therapists who accept their insurance — something that private citizens did to improve access to Covid-19 vaccines — would help.
But a large-scale impetus is needed. The AMA has the power and the reach to initiate these changes, if it calls it the way doctors and patients all over the country see it: This is an emergency, full stop.
Susan Hata is a pediatrician and internal medicine physician at Massachusetts General Hospital, where Thalia Krakower is an internal medicine physician. Both are Public Voices Fellows with The OpEd Project.