Mental Health: A Forgotten Facet of Primary Care

One of the biggest disparities in health care today is the separate treatment of mind and body, despite their known integration.¹ While mental and behavioral health conditions are frequently diagnosed and treated within primary care settings, fragmentation persists between the mental and physical health care systems—­creating barriers in the quality, outcome, and efficiency of care.² Since half of Americans with mental health conditions go without essential care, reform of our nation’s mental health system is a priority issue for NPs and PAs and the patients we serve.

Some progress has been made to implement change—the Now Is the Time initiative, launched in 2013, increased federal funding for behavioral health care workforce training in an effort to support more providers in mental and substance use disorder treatment. The Affordable Care Act (ACA) has worked to improve behavioral health coverage for Americans in three ways: ending insurance company discrimination based on pre-existing conditions, requiring health insurance coverage for mental and substance use disorder services, and expanding mental health parity. This has improved coverage and access to mental and substance abuse services for more than 60 million Americans.³ In January 2016, President Obama proposed a $500 million investment to increase access to mental health care.⁴ The most recent presidential election creates an uncertain future for mental health—particularly if the ACA is repealed. We do know, fortunately, that mental health care reform is part of the platform published by President-elect Trump.

Regardless, more work has to be done to guarantee that Americans have the access they need. Sadly, even with these advancements in behavioral health coverage, only about half of children and less than half of adults with diagnosable mental health disorders get the treatment they need.⁴ A 2016 report from the Rural Health Research Center revealed that more than 15 million Americans face behavioral health issues without access to the necessary care.⁵