The State of Mental Health Care in the United States
Mental health care has become a recognizable topic of discussion in the United States. More people are getting a diagnosis of mental health conditions that may have gone undiagnosed for years. The National Alliance on Mental Illness estimates 1 in 5 adults in the United States experience mental illness in a given year. Some people may find comfort in just knowing there is a clinical diagnosis for the symptoms they have been experiencing. Within the medical community, there is a growing awareness about the need for mental health services, and more providers are being trained to identify patients who may require immediate mental health services when they are seen in clinical practice.
For many individuals, the perception of mental health comes from what has been portrayed in movies, and some movies may more accurately portray the struggles and triumphs that can be experienced than others. For example, “A Beautiful Mind”—a movie about the true-life story of John Forbes Nash Jr, a mathematical savant who lived with schizophrenia—portrays mental illness in a positive light. The movie captures the challenges of the paranoia and delusions associated with schizophrenia but also highlights the ability for people to learn how to function with the illness.
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For most patients, daily management of symptoms is the key to continuous sustainability. Having the support of friends and family as well as understanding the goals of management can also help with long-term stability. As a health care professional, I recognize the importance of informing individuals about their medications and assisting them if they cannot access medications. Our ultimate goal as health care providers is to improve the quality of life for our patients living with mental illness and give them the opportunity to live and function similar to the general population.
Over the years, a movement away from institutionalization has allowed patients with a mental health condition to have some degree of normalcy. Living on their own or in group homes allows them to engage in everyday activities such as achieving employment. Pharmacologic management of schizophrenia, for example, can be in the form of first- or second-generation antipsychotics; these agents can be coupled with mood stabilizers if needed in some patients. The same can apply to individuals with bipolar disorder who may need combination therapy to manage their manic, hypomanic, or depressive symptoms. Whether the approach is nonpharmacologic, pharmacologic, or combination therapy, the goal is to achieve functionality and management of patients’ symptoms, which are often chronic.
In the last 5 to 10 years, issues related to funding for mental health care and access to services for the general population—including, most notably, for veterans—has been brought into the spotlight. As someone who has had the honor of training at 2 Veterans Affairs facilities, I have witnessed the need for mental health services to better target and manage conditions such as depression, anxiety, and posttraumatic stress disorder in this population and the need for positive outcomes associated with immediate and proper management.
The enactment of the Patient Protection and Affordable Care Act (ACA) in 2010 allowed an estimated 50 million to 60 million people who had been previously without coverage to access to mental health and substance abuse assistance. The increased access to mental health services in the form of the ACA was a significant milestone in the United States, but much more is needed.
Ambibola Farinde, PharmD, is a clinical pharmacist in Houston, Texas.