After comedian Robin Williams died, we asked how someone with access to the best help in the world wasn't able to find what he needed. Boston Globe columnist Kevin Cullen noted that for Williams, money was no barrier to the best possible care. So what's the verdict for ordinary people who are trying to find the help they need? "Accessing mental health care is getting harder, not easier," Cullen wrote. "It's getting more expensive for families, not less."
For a select group of our country's youth, the Affordable Care Act is good news. A recent study found that more young people are getting the mental health care and substance abuse treatment they need, thanks to the change allowing them to stay on their parents' insurance until age 26. This is excellent progress. But what about teens and young adults who have few resources, whose parents are uninsured and dealing with their own mental health needs? Cuts in mental health funding mean that these young people are less likely to have access to mental health care--and also that they are more likely to need it.
When we fail to treat childhood trauma, we pay for it later on, in tragic mental illness and costly health problems that perpetuate the cycle of childhood trauma for the next generation.
A recent analysis of the National Survey of Children's Health found that nearly half of children in the United States experience an "adverse childhood experience" and that the traumas of substance abuse, violence, and family mental illness are among the most common. As teens, kids who have experienced multiple traumas are more likely to have problems in school and to argue and bully. As adults, they're at a higher risk for a host of illnesses: alcoholism, depression, drug abuse, suicide attempts, smoking, poor health, heart disease, cancer, chronic lung disease and liver disease. Their own children experience the same suffering, and so the cycle begins again.
The only way to break the cycle is to invest in families. We need to get families greater access to mental health and substance abuse treatment, counsel parents and children to help them forge healthy bonds, and reach the kids who are starting to struggle -- by defusing problems before they begin with screening, referrals, and interventions. And like other chronic diseases, mental health conditions require not just crisis care but diligent aftercare for people to stay healthy.
That's where community-based mental health providers come in -- providers that work in at-risk communities and provide care mostly to people who are low income and on Medicaid. Community-based treatment is humane, effective, less costly than institutionalization, and a lifeline for people who can't otherwise afford care.
Yet states have dramatically slashed mental health funding by an estimated $4.35 billion between 2009 and 2012, even as the number of people relying on community-based systems increased by 1 million. Medicaid reimbursement rates make it impossible for many of these providers to keep their doors open. Youth behavioral health disorders alone cost the United States $250 billion each year, but only one in five are able to get the help they need. Minority children, uninsured children, and children whose parents are struggling with their own mental health issues are even less likely to get care.
It may be politically painless to make cuts to services for people who are often stigmatized and voiceless, but we will all share the cost of longer hospital stays, more emergency room visits, incarceration, and additional health care.
The worst loss is a human one -- lives that could be productive, fulfilling, and happy but that are instead hurting and even cut short. Mental health problems can be isolating and crippling even for people who can pay for the best care. By making mental health care difficult to afford, we create additional, often insurmountable obstacles for people who are already struggling at the margins. The lesson we learn from Williams is that this disease can reach anyone. The help we can provide should reach everyone, too.
Traci Donnelly is CEO and Executive Director of The Child Center of NY, a nonprofit that helps 18,000 children and their families each year. It is dedicated to strengthening children and families with the skills, opportunities, and emotional support to build healthy, successful lives. Connect with Traci on Twitter at @traci_donnelly
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Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.