Our mental health crisis requires action

When floods drown towns, first responders rescue stranded people, shelters open, and insurance adjusters arrive.

When flames engulf a neighborhood, firefighters swarm the scene.

This is what crisis response looks like. It’s urgent, and focused on helping those in need.

We all agree this country is in the midst of a mental health crisis. More than one of five adults experiences mental illness. Children have never been so depressed and anxious, thanks in part to social media so addictive that some Long Island child development advocates and their peers nationwide cheer a lawsuit against the corporate owner of Instagram and Facebook. Cities struggle to provide even basic help to those with acute mental health issues. Suicide rates quickly returned to near their pre-pandemic peak after a brief lull during lockdowns, while alcohol and drug-related deaths peaked.

It's hardly a new crisis — but where is the response? Only this month did Gov. Kathy Hochul expand loan repayment for mental health professionals, to help attract more. And Northwell's $500 million investment announced last week for child and adolescent mental health is welcome. Still, it took until September for the Biden administration to use its leverage over recalcitrant insurance companies, with a law that has penalties if they fail to cover mental health care as they do physical health care.

And to be clear, they have failed. A recent national survey from NORC at the University of Chicago, and one on Long Island by Mount Sinai South Nassau, found:

• Some 57% of patients nationally who repeatedly sought care for mental health or substance abuse got no care at least once. It was worse for children — 69% got no care at least once.
• More than one of three Long Islanders struggled to find mental health care, even though almost all had insurance.
• Almost 40% of patients in employer-sponsored health plans had to go out of network to get care, incurring further costs.
• Almost half of Long Islanders say government isn’t doing enough to help.

They’re right.

Nearly half the nation lives in areas underserved by mental health professionals, and that’s likely to get worse. Most mental health workers are dealing with burnout. Many are considering quitting. For every mental health professional, 350 people need their help. It’s untenable.

Yet we as a society continue to do close to nothing.

For 15 years, federal law has required that insurance providers offer equivalent access between mental health and medical care. Patients and providers know that law has been a cruel joke. As both the NORC and Mount Sinai South Nassau surveys show, patients struggle to find insurance-covered care, and insurance companies do little to help them find it. Providers quit insurance panels because companies underpay providers, then second-guess and limit the care providers give.

President Joe Biden's September threat to finally enforce the law was not nothing, but when more than 50 million Americans have mental health issues and more than 12 million are seriously considering killing themselves, it's not enough.

There are some initial steps we could take. Insurers should start paying mental health practitioners a higher rate, and do so on time. That would encourage therapists to stay on insurance company panels and continue to accept insurance. And insurers should remove providers who no longer accept insurance or new patients and stop pretending they have more providers than they do.

Right now, we are just turning a garden hose on a city fire. We must do better.

This guest essay reflects the views of Martha Fling, president and chief executive of Manhattan-based Ackerman Institute for the Family, which trains therapists in family therapy and offers family therapy.