W#7 Peer replies

POST # 2 CAROLINE

· Briefly describe the availability of and access to mental health care in your community and geographical area.

· What do you see as the greatest barrier to access and how do you feel this would be best addressed? Be specific in regard to addressing this issue in your “community" or geographical area. Do you believe that private or public entities are best suited to address this?

Approximately 1 in 5 Americans has some type of mental health condition and spending on mental health treatment and services reached $225 billion in 2019, according to an Open Minds Market Intelligence Report (Leonhardt, 2021). That number, which is up 52% since 2009, includes spending on things like therapy and prescription medications as well as stays in psychiatric or substance abuse rehabilitation facilities (Leonhardt, 2021). 

Arizona ranks close to last in the nation when it comes to available mental health care providers, Arizona ranks 47th among all 50 states and the District of Columbia in the rate of available mental health care providers, according to the latest report by the nonprofit group Mental Health America. The state’s ratio of 790 people for every 1 provider compares with Massachusetts' leading rate of 180 to 1. (TABHW, 2020). In the 2016, 13.6% of Arizonans reported they could not afford needed health care. This is higher than national average of 12.1% but represents a decrease in Arizona from its 2012 percentage of 19.8%. Twenty-three percent of people in the unable to work category reported not being able to see a doctor because of cost (Arizona Department of Health Services, 2017). 

One barrier to getting mental healthcare includes living in the rural area. Rural barriers to behavioral health care include longer travel distances to providers, lack of behavioral health workforce, and stigma. These barriers are compounded by the small behavioral health workforce in rural areas (Hough, Willging, Altschul, & Adelsheim, 2011). Another barrier to accessing mental health care include stagnation in psychiatry and primary care residency training programs. Psychiatrists may be less likely to accept Medicaid as well as private health insurance (Olfson, 2016).

Barriers can be addressed by policies that address the Social Determinants of Health using a population health framework can be implemented to prevent illness and promote behavioral health. This includes improving access to safe housing, stable employment, quality education, and supporting food security and safe communities. Using a population health framework to reduce the experiences of ACES among children includes strengthening family economic support, promoting protective social norms, and implementing early childhood health care and education, parenting education, and positive youth activities and mentorship (Merrick et al., 2019). Reducing stigma and increasing the availability of linguistically and culturally competent providers may also address barriers to accessing behavioral health care and improve engagement in services and outcomes (AACAP, 20190) I believe that both private and public entities must work together to address the issue of access to mental healthcare in Arizona. REFERENCES AACAP. (2019). Improving access to mental health: Reducing mental health stigma. (). Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/Advocacy/policy_resources/Improving-AccessStigma.pdf Arizona Department of Health Services. (2017). Arizona behavioral health risk factor surveillance system. Retrieved from https://www.azdhs.gov/preparedness/public-health-statistics/behavioral-risk-factorsurveillance/index.php#hdr Leonhardt, M. (2021) What you need to know about the cost and accessibility of mental health care in America: https://www.cnbc.com/2021/05/10/cost-and-accessibility-of-mental-health-care-in-america.html Olfson, M. (2016). The rise of primary care physicians in the provision of US mental health care. Journal of Health Politics, Policy and Law, 41(4), 559-583. Hough, R. L., Willging, C. E., Altschul, D., & Adelsheim, S. (2011). Workforce capacity for reducing rural disparities in public mental health services for adults with severe mental illness. Journal of Rural Mental Health, 35(2), 35. Merrick, M. T., Ford, D. C., Ports, K. A., Guinn, A. S., Chen, J., Klevens, J., . . . Daniel, V. M. (2019). Vital signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention—25 states, 2015–2017. Morbidity and Mortality Weekly Report, 68(44), 999. The Arizona Behavioral Health Workforce (2020). https://crh.arizona.edu/sites/default/files/publications/20201117_AZ_BH_Workforce_FINAL.pdf