UM Mental Healthcare During COVID 19 and Mental Retardation Analysis

Literature Review

Use the four articles that you found for your

annotated bibliography as well as other resources

as needed to write a literature review on your

chosen topic. Cover the following topics in your

literature review. Hint: consider using the topics

below as headings. Your literature review should

be 5-8 pages.

Introduction: Write an introduction to your paper

with a strong thesis statement.

Review of Research: What does the research tell

us about this topic? What are the findings of

studies?

Treatment Approaches: What treatment

approaches, programs, or interventions are

effective in addressing the problem you have

chosen?

Implications for the Future & Conclusion: What

are the implications of findings of research and

what we know about treatment for social workers

in the future? What is your conclusion?

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Colisa Winters
University of Memphis
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Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012, September).
Burnout in mental health services: A review of the problem and its remediation. Administration
and policy in mental health. Retrieved March 20, 2022, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156844/
This journal discusses the effects of social workers and their feelings as a result of budget cuts in
mental health. This will be helpful to explain that the social worker field is already in high
demand and if people feel burnt out they will stop working in the field of mental health. I plan to
tie this into a reason why funding is needed and what could happen if it is not funded.
New Study reveals lack of access as root cause for mental health crisis in America. National
Council. (n.d.). Retrieved March 20, 2022, from https://www.thenationalcouncil.org/pressreleases/new-study-reveals-lack-of-access-as-root-cause-for-mental-health-crisis-in-america/
This article addresses past cuts of mental health. This also explains that the reason mental health
is cut is due to how much it costs to treat people. This article is extremely helpful to show how
the American government has always made consistent cuts in funding for mental health.
Wong, E. Y., Schachter, A., Collins, H. N., Song, L., Ta, M. L., Dawadi, S., Neal, S., Pajimula,
F.
., Colombara, D. V., Johnson, K., & Laurent, A. A. (2021). Cross-Sector Monitoring and
Evaluation Framework: Social, Economic, and Health Conditions Impacted During the
COVID-19 Pandemic. American Journal of Public Health, 111(S3), S215–S223.
https://doi-org.ezproxy.memphis.edu/10.2105/ajph.2021.306422
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This book was accessed from the University of Memphis Library. The book is in a PDF
format and will not allow me to copy it directly for the attached readings. This book discusses
the increase for mental health to be addressed during the pandemic. This book talks about there
is over an 100% increase with needing to address sucide, depression and alcoholism. This will be
helpful to demonstrate why there is a need for funding to increase and not decrease especially in
current times.
World Health Organization. (n.d.). Who report highlights global shortfall in investment in
Mental Health. World Health Organization. Retrieved March 20, 2022, from
https://www.who.int/news/item/08-10-2021-who-report-highlights-global-shortfall-ininvestment-in-mental-health
This article addresses that Mental Health on an international level is still underfunded.
This also discusses that fifty-one percent of 172 had complied with meeting expectations for
funding for mental health. This is important for my topic, because I have decided to address the
issue of mental health and social work. This will be used to demonstrate the great need for
funding for mental health.
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Mental Health Care Was Severely
Inequitable, Then Came the
Coronavirus Crisis
COVID-19 has exposed the disparities in the U.S. mental health
system, leaving many Americans without accessible and affordable
care as policymakers fail to adequately address the crisis.
AUTHORS
●
● Azza Altiraifi
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●
● Nicole Rapfogel
Advancing Racial Equity and Justice, Building an Economy for
All, Strengthening Health and Ending the Pandemic, Coronavirus,
COVID-19, Disability, Health and Well-Being, Health Care, Mental
Health, Poverty
MEDIA CONTACT
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GOVERNMENT AFFAIRS
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DOWNLOAD
A person stands alone in front of a closed middle school in
Philadelphia on April 14, 2020. (Getty/NurPhoto/Cory Clark)
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Introduction and summary
People with mental health disabilities, like other historically oppressed
communities, are experiencing compounded harms due to the COVID19 pandemic. This is because sanism—oppression that has
systematically disadvantaged people perceived or determined to be
mentally ill—pervades public policy and life in the United States.1
People with mental health disabilities face disproportionately high
rates of poverty, 2 housing and employment discrimination,3 and
criminalization.4 The economic and social upheaval caused by the
coronavirus outbreak has merely exacerbated these disparities for
those who were disabled prior to the crisis, while also exposing scores
more people to individual and communal trauma, loss, and
uncertainty.
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As the coronavirus crisis continues to wreak havoc on communities,
the need for accessible, culturally affirming mental health support
services has never been more acute. However, even before the
pandemic, the U.S. mental health care system was already failing to
meet people’s needs. In particular, for people of color and people with
marginalized gender identities, the system too often operates in
oppressive ways.5 The psychiatric establishment, whose leadership is
overwhelmingly white and male,6 has historically denied communities
facing various forms of oppression any control over their mental health
care. Today, treatment is often cost-prohibitive, scarce, and coercive.
This report lays out the existing barriers to accessing affordable and
affirming mental health services and considers the impact of COVID19 on an already strained and inequitable mental health system. It
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also recommends that local, state, and federal governments take the
following actions:
● Provide an immediate increase in funding to Medicaid providers
and in-need communities.
● Increase funding for peer support and community-based
services.
● Address the social determinants of mental health.
● Commit to permanently funding these policies.
Dangers of institutionalization
While the focus of this report is on noninstitutionalized populations, it
is critical to note that people institutionalized within psychiatric facilities
throughout the United States are acutely vulnerable to infection and
death during the pandemic.7 Confining people within congregate
settings is inherently dangerous to their health and well-being, and
people with mental illness are disproportionately represented in
carceral facilities, institutions, and similar environments.8 Indeed, with
the coronavirus spreading unabated in jails, prisons, veterans’
hospitals, nursing homes, and psychiatric facilities, large-scale
investment in community-based services and supports could not be
more urgent.9 Furthermore, states must reduce the populations of
psychiatric hospitals and other congregate care facilities by scaling
back admissions and expediting discharges.10
Analysis of disparities
Preexisting barriers to mental health care access
For many Americans, mental health care has been unaffordable and
inaccessible well before the coronavirus pandemic. A national
shortage of mental health providers, the high price of care, and a lack
of insurance coverage for mental health services all make it difficult for
people with mental health disabilities to access care. In 2016, 11.8
million Americans had a need for mental health services that went
unmet; of these, nearly 38 percent could not afford the cost of
treatment.11 Moreover, only about 1 in 5 people with a substance use
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disorder received treatment in 2016, and only slightly more than 40
percent of adults with any mental illness received treatment in 2017.12
Critically, the intersection of systemic sanism and racism fuels the
many disparities laid bare by the COVID-19 pandemic. Racial groups
that have historically been discriminated against—such as African
Americans, American Indians, and Alaska Natives—use mental health
services at substantially lower rates than white Americans.13 There
are myriad reasons for this, including geographic inaccessibility,
economic disenfranchisement, lower rates of insurance coverage, and
mistrust of the health care system due to years of abuse, neglect, and
coercive treatment.14 For example, the coronavirus has been
especially devastating in Native communities, with the Navajo Nation
reporting among the highest per-capita infection rates in the country
for several months.15 Unmet treaty obligations by the federal
government resulting in chronic underfunding of critical services,
paired with colonialism and ecological devastation, have contributed to
the high infection and mortality rates in Indian Country.16 As COVID19 continues to infect and kill Black, Native, and Latinx people at rates
that far outpace those of white people, equitable access to affirming
mental health supports has become increasingly imperative.17
Survey data collected by the U.S. Census Bureau show that clinically
significant symptoms of depression and anxiety have more than tripled
since the coronavirus pandemic began, with people of color
disproportionately affected.18 Recent data also show that following
the release of video footage of George Floyd’s murder at the hands of
Minneapolis police officers, the share of Black people suffering from
psychological distress symptoms associated with depression and
anxiety—such as feelings of hopelessness or uncontrollable worry—
jumped from 36 percent to 41 percent.19 This has grave implications,
as the communities bearing the heaviest mental health burdens are
the communities that face the steepest barriers to accessing equitable
mental health treatment and support.
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For people without insurance coverage, out-of-pocket costs to mental
health coverage are far from affordable. Notably, people of color are
more likely than non-Hispanic whites to be uninsured, with Hispanic or
Latinx Americans, American Indians, and Alaska Natives all being
more than 2 1/2 times more likely than non-Hispanic whites to be
uninsured.20 Even those with insurance coverage often experience
difficulties accessing mental health services. More than half of U.S.
counties have no practicing psychiatrists, 37 percent of counties have
no psychologists, and two-thirds of counties have no psychiatric nurse
practitioners; nonmetropolitan counties have an even higher likelihood
of having no accessible providers.21 Moreover, psychiatrists are far
less likely than other providers to accept any type of insurance: While
73 percent of other providers accept Medicaid, only 43 percent of
psychiatrists accept Medicaid.22 And slightly more than half of
psychiatrists accept Medicare and private insurance, compared with
more than 86 percent of other providers.
While federal parity regulations prohibit insurers from restricting
mental health coverage any more than they limit coverage for other
medical services, these policies largely do not require insurers to be
transparent and accountable with beneficiaries.23 To increase parity,
it is essential that there are network adequacy provisions ensuring that
mental health coverage includes a sufficient number of providers that
are both accessible and taking new patients; yet unfortunately, these
regulations are often left out of parity enforcement. Subsequently,
many insured patients with mental health disabilities are unable to find
an in-network provider that is willing to see them, even though their
insurer, by law, must cover mental health services. Although a limited
number of plans offer some out-of-network coverage, many people
who are insured may have to pay the full out-of-pocket costs of
services or forgo care when they cannot find in-network providers.
Impact of social isolation and economic uncertainty
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Social distancing requirements, including stay-at-home orders, are
undoubtedly important tools to slow the spread of the coronavirus.
However, social isolation can also be detrimental to many people’s
mental health, exacerbating preexisting conditions and adding to
newfound mental health concerns. It is therefore essential to provide
support for people struggling with several weeks or months of social
isolation during the pandemic.
Around the world, prolonged social isolation is exacerbating many
individuals’ psychiatric symptoms and increasing incidence of
psychiatric disability. For example, a survey of quarantined children in
Hubei, China, found that 1 in 5 children reported experiencing
depressive symptoms—a rate that is significantly higher than it was
before the pandemic.24 Among U.S. adults surveyed, nearly half of
those sheltering in place reported negative mental health effects,
compared with 37 percent of those not under stay-at-home orders.25
Moreover, an analysis featured in the medical journal The Lancet
found that people who have been asked to isolate at home or in
quarantine facilities reported high levels of “negative psychological
effects including post-traumatic stress symptoms, confusion, and
anger.”26 And another survey found that about one-third of adults in
the United States have felt lonelier than usual during the coronavirus
pandemic.27 Notably, chronic loneliness is associated with numerous
adverse mental and physical health outcomes.28
The COVID-19 pandemic has also sparked an unprecedented
economic crisis, with the United States entering what is likely to be an
extended and deep recession. This downturn is disproportionately
burdening people with disabilities, communities of color, people with
marginalized gender identities, and those at the intersection of these
identities, while also exposing them to trauma, stress, and
uncertainty.29 A systematic review of the impact of the 2008 Great
Recession on health found that an increase in distress symptoms and
mental illness coincided with the economic crisis.30 Given that
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socioeconomic status is an important social determinant of mental
health, the COVID-19-induced recession—as well as economic
uncertainty and job loss at all income levels—is likely to exacerbate or
trigger new incidences of psychiatric disability.31
Furthermore, the economic fallout of the pandemic is
disproportionately burdening Black, Native, and Latinx communities.
People of color are more likely to work in essential jobs that put them
on the frontlines of the pandemic.32 Essential workers—particularly
women and people of color—are also nearly twice as likely to use the
Supplemental Nutrition Assistance Program (SNAP), may struggle to
afford child care amid closures of schools and their regular child care
arrangements, and may have to pay for personal protective equipment
(PPE) out of pocket.33 Additionally, the racial wealth gap may
preclude people of color from taking unpaid time away from work
since they often lack the personal savings necessary to do so.34
Making matters worse, occupational segregation and racism in the
labor market mean that Black and Latinx people are less likely to have
access to paid family or medical leave if they or a family member
needs care for mental or physical illnesses.35 As such, these
communities face compounded harms and bear an outsize share of
the mental health and economic fallout of the coronavirus crisis.36
Frontline health care workers and emergency medical services
workers are also facing unprecedented burdens as a result of the
pandemic. The World Health Organization recently released a policy
brief on the need for proactive mental health action during the
pandemic, with specific attention given to health care workers treating
patients with COVID-19.37 Frontline health workers experience
elevated levels of stress, anxiety, insomnia, and depression. And
preliminary research in the United States shows high levels of
psychological and emotional distress among health care workers
directly treating coronavirus-infected patients. In a May survey, nearly
3 in 5 health care workers said that their mental health has worsened
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due to the coronavirus pandemic.38 Continued PPE shortages, long
and physically demanding shifts, the emotional burden of treating and
sometimes losing colleagues to the illness, and the ever-present fear
of spreading COVID-19 to loved ones are causing severe emotional
and mental strain for frontline health providers.39
Despite these challenges, there are few accessible options for tailored
mental health supports for these frontline workers. Volunteer trauma
crisis response groups, peer support networks, and specialists in
trauma-informed therapy have mobilized to reach health care workers,
but the need outpaces the availability.40 Furthermore, many
physicians delay or forego needed mental health treatment because
they could face steep repercussions from state licensing boards, 90
percent of which still require physicians to disclose details of their
mental health history.41 While symptoms of distress will abate for
many once the crisis is under control, others may develop traumarelated psychiatric disabilities requiring long-term support.
This underscores the need for long-term investment in mental health
services for populations experiencing higher rates of trauma exposure.
Moreover, those seeking out and receiving treatment should not face
professional barriers.
A rise in abuse
Panic, uncertainty, social isolation, and economic devastation can, in
turn, exacerbate or trigger new forms of child abuse and intimate
partner violence.42 Alcohol abuse, controlling behaviors,
unemployment, and limited access to social support systems are
factors associated with family violence that have become more
common during this crisis.43 Globally, reports of domestic violence
have tripled in China and risen by 30 percent in France and by 40 to
50 percent in Brazil, indicating broader global patterns of rising rates
of domestic violence during the pandemic.44 While data on domestic
violence in the United States are limited,45 several agencies have
reported increased rates of physical and emotional abuse during the
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pandemic and new forms of pandemic-related manipulation.46 As
such, it is essential to provide ongoing tailored support for survivors of
intimate partner violence and child abuse both during and following
this crisis.
Disruption of services
Physical distancing policies, including stay-at-home orders, have also
made it difficult for people with mental health concerns to access inperson psychiatric and peer support services. Peer support refers to
the guidance, care, and nonclinical support services provided by
people with lived experience of mental health disability, trauma, and/or
substance use disorders; this model of care emerges from the selfadvocacy and organizing of psychiatric service users and survivors.47
Extensive research has demonstrated its efficacy in reducing
hospitalization and symptoms associated with severe emotional
distress.48 Furthermore, peer support promotes an affirming and
equitable model of healing that equalizes the inherent power
imbalance in traditional clinical relationships.49 There are several
types of peer support programs and modalities, including peer-led
respite crisis centers, one-on-one recovery and virtual meal support
for people with eating disorders, and the Alternatives to Suicide
approach, which creates spaces for people to safely share their
experiences with suicidality and acute emotional distress.50 However,
program disruptions caused by the pandemic have threatened the
continuity of some of these services.
While some peer support services have managed to ensure continuity
of care by transitioning online, pandemic-related movement
restrictions have disrupted most in-person mental health outreach in
underserved communities. These services, performed by peer
workers, community health workers, violence disruptors, and others
are critical to expanding service utilization for people living in
communities wracked by high rates of violence, displacement,
economic disinvestment, ecological destruction, and other forms of
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oppression.51 The cessation of such in-person outreach is likely to
cause adverse mental health outcomes. According to a recent survey
of 880 community behavioral health care organizations, 61 percent
have shuttered at least one program due to the pandemic; and nearly
all of organizations surveyed have reduced their operations.52
As pandemic-related closures and distancing policies continue, many
people have turned to telehealth platforms and mental health apps as
an alternative. Telehealth can be an important option for patients who
cannot access in-person services. However, policymakers must
consider privacy concerns and disparate access to broadband, as well
as adequately regulate telehealth services as more Americans use
virtual options. While detailed recommendations on telehealth are
outside the scope of this report, further research is needed.
Recommendations
In order to sufficiently meet people’s needs, it is essential that all
funding and reforms put in place during this pandemic remain in place
after the emergency declaration expires. Responses to trauma are
often delayed, and it is likely that individuals’ psychiatric symptoms will
continue long after the initial spread of the coronavirus is contained.
As such, funding to adapt to the current situation, as well as long-term,
sustained efforts to offer supports and access to services, will be
needed in order to properly address pandemic-related psychological
and emotional distress.
Expand access to health care coverage
There are several important, immediate steps that can be taken to
expand health care coverage. Amid rampant job loss,53 risk of
infection and hospitalization,54 and increased need for mental health
services,55 universal health coverage has never been more important.
However, the current administration in the White House is committed
to undermining health insurance coverage through its attacks on the
Affordable Care Act (ACA) and Medicaid, making this approach
unattainable for the time being.56 As an intermediate step, federal and
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state governments can and should make every effort to offer
affordable coverage to the uninsured within the existing ACA and
Medicaid infrastructure.
Under the ACA, people who face certain life events—such as the loss
of employer-sponsored health insurance, moving, marriage, or the
birth or adoption of a child—qualify for a special enrollment period
(SEP), during which they can sign up for marketplace coverage
outside of the yearly open enrollment period.57 Twelve states that
operate their own state-facilitated marketplaces have opened a
COVID-19-specific SEP that allows currently uninsured individuals to
obtain individual market coverage, regardless of whether they qualify
for a traditional SEP.58 According to estimates by health care analyst
Charles Gaba, in the eight states that have opened COVID-19 SEPs
and are reporting data, at least 240,000 people already have enrolled
in coverage using this pathway.59
The Trump administration, however, has refused to implement an SEP
for the federally facilitated marketplace in response to the COVID-19
pandemic. Gaba estimates that approximately 920,000 people
nationally would enroll in ACA coverage if the federal government
opened a national COVID-19 SEP.60 Allowing more people to enroll
in coverage would not only alleviate some of the financial concerns
associated with fears of getting sick contributing to individuals’
psychological distress, it would also allow more people to access
mental health services.
The Health and Economic Recovery Omnibus Emergency Solutions
(HEROES) Act, which passed the U.S. House of Representatives in
mid-May but has stalled in the Senate, establishes an SEP for the
ACA marketplaces.61 It is essential that this provision be included in
the final package that passes Congress. In addition to establishing an
SEP, policymakers must fund culturally appropriate outreach and
enrollment efforts to allow people experiencing job loss to access
health care coverage.
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Millions of low-income Americans would not have access to
coronavirus testing and treatment or mental health care services
without the Medicaid program. As the Center for American Progress
detailed in June, to streamline Medicaid enrollment for millions of
unemployed folks who may have lost their employer-sponsored
insurance, states should offer automatic enrollment into Medicaid
expansion for the unemployed and receive 100 percent federal
funding through the federal matching assistance percentage
(FMAP).62 Moreover, states that have not expanded Medicaid must
do so to cover individuals who fall into the coverage gap. More than
two million Americans currently do not qualify for traditional Medicaid
in their states but also do not have high enough incomes to qualify for
financial assistance on the individual market.63 In states that refuse to
expand Medicaid, the federal government should offer a Medicaid
option for the unemployed that mimics the state-based option.64
To further support low-income individuals, presumptive eligibility is
another important provision to allow uninsured and low-income people
to access care. Presumptive eligibility allows certain health care
providers to enroll patients who would likely qualify for Medicaid into
the program for a limited amount of time, typically no more than two
months.65 Thirty-one states currently offer presumptive eligibility in
certain settings, but most limit qualification to pregnant women and
children; and all but eight states exclude childless adults.66
Furthermore, hospitals are one of the few entities qualified to use
presumptive eligibility.67 Therefore, many uninsured people may need
to seek mental health care in a hospital setting, which could risk their
exposure to the coronavirus.
Based on recommendations from the Center for Law and Social Policy
(CLASP), there are several steps that states can take to make
presumptive eligibility more effective.68 States can expand qualified
entities that are able to screen for eligibility to include “urgent-care
facilities, child care facilities, youth serving agencies, testing sites, and
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virtual options.”69 As CLASP suggests: “Just as pregnant women are
allowed one period of presumptive eligibility per pregnancy, individuals
exposed to COVID-19 should be allowed one period of eligibility per
COVID-19 exposure. Multiple periods are especially critical for
essential workers without insurance who risk multiple exposures
throughout the pandemic.”70 Lastly, presumptive eligibility should be
available to all potentially Medicaid-eligible individuals.
States should encourage presumptive eligibility providers to assist
their patients with submitting a full Medicaid application when using
presumptive eligibility in order to gain longer-term Medicaid
coverage.71 This would also allow people to keep their presumptive
eligibility coverage until a decision on a full application is made.
Additionally, states can apply for Section 1115 waivers to extend
presumptive eligibility for a longer period.72
Provide immediate funding to key providers and in-need
communities
While previous stimulus packages have included important supports
for providers, clinics, and hospitals, additional funding is urgently
needed to address the needs of mental health patients and providers.
For instance, the Coronavirus Aid, Relief, and Economic Security
(CARES) Act, passed by Congress and signed into law by the
president at the end of March, allocated $250 million to certified
community behavioral health centers as well as funding for state and
local aid.73 Meanwhile, the Families First Coronavirus Response Act
increased the share of Medicaid payments covered by the federal
government—the FMAP—by 6.2 percentage points through the end of
the quarter in which the public health emergency ends. And if it
passes the Senate, the HEROES Act would raise the FMAP by 14
percentage points through June 30, 2021; if the public health
emergency extends beyond that, the FMAP would return to its original
increase of 6.2 percentage points.74 However, the definition of eligible
services for the FMAP bump excludes most community mental health
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services.75 Furthermore, community-based behavioral health
providers have received little of the CARES Act funding intended to
keep providers in business.76 For these reasons, the Senate must
pass the FMAP increase, and Congress as a whole must ensure that
critical community mental health services are eligible for the FMAP
increase, while also being mindful that federal Medicaid assistance
may need to extend beyond the scope of the public health emergency
as communities continue to face the repercussions of the
pandemic.77
Additionally, the $1 billion allocated in the CARES Act is woefully
insufficient to meet the significant health needs of tribal nations during
the pandemic and in its aftermath. Numerous short-term and longterm policy changes, as outlined in a recent CAP report, are needed to
redress the federal government’s broken treaty obligations, which
have led to disproportionately high rates of COVID-19 infection and
mortality in Native communities.78
Improve funding for peer support services and other communitybased services
In times of crisis, peer support services are critical. Given the
challenges faced by frontline health care workers, essential workers,
survivors of COVID-19, the millions of people grieving loved ones, and
communities—particularly Black, Latinx, and Native communities—
disproportionately affected by the virus, increased access to
affordable mental health services must be coupled with targeted
funding for peer-to-peer supports.79 Accordingly, the Substance
Abuse and Mental Health Services Administration must provide grants
to peer and mental health support groups by and for people affected
by the coronavirus pandemic.
Reports suggest that this pandemic has caused a surge in the number
of people with lived experience seeking to complete their peer support
certifications.80 Many peer-led support groups and services have
transitioned to online models in order to maintain continuity of care.
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The CARES Act allocated $200 million to the Federal
Communications Commission to disburse funds for telehealth and
peer support services that fall within its purview.81 However, this
funding is woefully insufficient to meet the increased demand and to
support the costs of rapidly training up people who can provide
tailored and culturally affirming resources to those acutely in need.
Critically, peer support specialists and community health workers are
developing innovative strategies to conduct outreach to underserved
populations and provide tailored support. For example, the 30 million
people with eating disorders in the United States are facing new
pandemic-related stressors due to elevated concerns about food
scarcity and the hoarding of groceries by shoppers, coupled with a
surge in media content focused on food and weight.82 Solutions such
as online meal support groups can connect underserved populations
with people who have a shared understanding of the unique
challenges this pandemic poses.83 Adequately funding such services
through operational grants that extend beyond the duration of the
pandemic is crucial to ensuring continuity of care. Furthermore,
increased federal funding for peer support training is essential to
bolstering existing state and local peer certification programs and
facilitating outreach efforts that target the most affected populations
during and in the aftermath of the pandemic.
Invest in social determinants of mental health
While there clearly are protracted mental health impacts of the
COVID-19 pandemic, the Trump administration’s claim that lifting stayat-home orders is necessary to curb suicide rates obscures the reality
that much of this distress is due to the administration’s failure to
mobilize a pandemic response that meets people’s basic needs.84
Until the government adequately contains the coronavirus and
provides economic and social support to those affected, Americans
will continue to face increasing distress and trauma.85
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Psychiatric service provision and the incidence of mental health
disability are shaped by the oppressive and traumatizing social
conditions many people navigate daily. Racism, sanism, and other
structures of oppression produce social and institutional arrangements
that put some groups at risk of poorer health outcomes and premature
death while allocating life-sustaining resources to others.86 Extreme
social stratification and years of deliberate policy designed to unravel
the social safety net have left huge swaths of the country—
predominantly people of color, disabled people, and low-income
people—unable to access life-sustaining resources.87 As such,
without full investment in permanent housing solutions,88 expanded
food assistance through the SNAP,89 and the elimination of asset
limits and other cumbersome barriers to public assistance, distress will
only be elevated.90 The behaviors that biomedical perspectives on
psychiatry have defined as “disordered” are often the outcome of
survival behaviors to cope with extreme and oppressive
circumstances. Investing in the social determinants of mental health
and redressing years of oppressive policymaking would ensure that
the mental health interventions deployed in the wake of this crisis do
not bolster the oppressive power structures that fomented such
distress in the first place.91
Conclusion
The explosive spread of the novel coronavirus underscores the
importance of transforming mental health care in the United States
and redressing the structural inequities baked into the psychiatric
establishment and mental health policy. Even prior to the COVID-19
pandemic, people with mental health disabilities faced numerous
barriers in accessing competent, affordable and culturally affirming
care; this crisis has merely exacerbated these inequities.
Local, state, and federal governments must address the new
challenges this crisis poses for people experiencing acute
psychological distress or trauma. Their actions must be swift,
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comprehensive, equitable, and sustainable through the long-lasting
impact of the virus.
About the authors
Azza Altiraifi is a research and advocacy manager for the Disability
Justice Initiative at the Center for American Progress.
Nicole Rapfogel is a research assistant for Health Policy at the Center.
Acknowledgements
This report is a collaborative effort between CAP’s Disability Justice
Initiative and its Health Policy team. The authors would like to thank
Areeba Haider and Justin Schweitzer for their fact-checking
assistance, as well as Lily Roberts, Danyelle Solomon, Adam Conner,
and the Editorial team for their contributions.
New Study Reveals Lack of Access as Root
Cause for Mental Health Crisis in America
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Paul Wood, Cohen Veterans Network, (203) 569-0289
Joy Burwell, National Council for Mental Wellbeing, (202) 748-8789
Kaitlyn Rawlett, Weber Shandwick, (212) 445-8082
New Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America
Mental health services in the U.S. are insufficient despite more than half of Americans (56%) seeking help
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Limited options and long waits are the norm, but some bright spots with 76% of Americans now seeing
mental health as important as physical health
Washington, D.C. – October 10, 2018 – Today, Cohen Veterans Network (CVN), a national not-for-profit
philanthropic organization, and National Council for Mental Wellbeing, the unifying voice of America’s
health care organizations that delivers mental health and addiction treatment and services, issued the
inaugural America’s Mental Health 2018, a comprehensive study of access to mental health care, at the
2018 Cohen Veterans Care Summit in Washington D.C. The study, which assesses Americans’ current
access to and attitudes towards mental health services, revealed American mental health services are
insufficient, and despite high demand, the root of the problem is lack of access – or the ability to find care.
The study offers a comprehensive analysis of the state of mental health care in the U.S. It is comprised of
a two-pronged research project that includes an online survey of 5,000 American adults, and a robust
analysis of third-party data measuring patients’ access to mental health services in terms of four pillars –
providers, facilities, funding and perceived satisfaction among patients.
“There is a mental health crisis in America. My experience establishing mental health clinics across the
country, coupled with this study, shows that more needs to be done to give Americans much needed
access to mental health services,” said Cohen Veterans Network President and Chief Executive Officer
Dr. Anthony Hassan. “If we want to save lives, save families and save futures we must reimagine our
behavioral health system and take concrete steps to improving consumers’ ability to find the care they
need, when they need it, and on their terms.”
Despite Strong Demand for Mental Health Services, Common Barriers Remain
The demand for mental health services is stronger than ever, with nearly six in 10 (56%) Americans
seeking or wanting to seek mental health services either for themselves or for a loved one. These
individuals are skewing younger and are more likely to be of lower income and have a military
background. The large majority of Americans (76%) also believe mental health is just as important as
physical health.
“This study confirmed what we hear from our members every day, that individuals and families continue to
struggle to find the help they desperately need,” said Linda Rosenberg, President and CEO of National
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Council for Mental Wellbeing. “Mental health and addiction providers need adequate funding to hire
skilled staff, employ evidence-based practices and adopt innovative technologies – all of which will help
us meet demand.”
Despite this strong demand and growing societal awareness of the importance of mental health in the
U.S., the study revealed that the overwhelming majority of Americans (74%) do not believe such services
are accessible for everyone, and about half (47%) believe options are limited.
These beliefs are driven by several perceived barriers in Americans’ ability to seek mental health
treatment, including:
High Cost and Insufficient Insurance Coverage: Forty-two percent of the population saw cost and
poor insurance coverage as the top barriers for accessing mental health care. One in four (25%)
Americans reported having to choose between getting mental health treatment and paying for
daily necessities.
Several individuals blamed the U.S. government and insurers for not providing enough funding and
support for access. Nearly one in five of Americans, or 17%, noted they have had to choose between
getting treatment for a physical health condition and a mental health condition due to their insurance
policy. The majority (64%) of Americans who have sought treatment believe the U.S. government needs
to do more to improve mental health services.
Limited Options and Long Waits: Access to face-to-face services is a higher priority for Americans
seeking mental health treatment than access to medication. Ninety-six million Americans, or 38%,
have had to wait longer than one week for mental health treatments. And nearly half of
Americans, or 46%, have had to or know someone who has had to drive more than an hour
roundtrip to seek treatment.
While most Americans have heard of telehealth as an option for treating mental health issues, only 7%
have reported using it. When asked if they would be open to using it, almost half, or 45%, of Americans
who have not already tried telehealth services said they would be open to the idea of trying a service to
address a current or future mental health need.
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Lack of Awareness: While most Americans do try to seek out treatment, there also is a large
portion of the population who have wanted to but did not seek treatment for themselves or loved
ones (29%)– in part due to not knowing where to go if they needed this service. What’s more,
fifty-three million American adults (21%) have wanted to see a professional but were unable to for
reasons outside of their control.
Furthermore, younger Americans (i.e., Gen Z and Millennials) are less sure about resources for mental
health services, compared to older generations. This younger generation was also more likely to find it
too hard to figure out legitimate resources online. Instead, many turned to unreliable resources for
information, including Facebook, YouTube and Twitter.
Social Stigma: Nearly one-third of Americans, or 31%, have worried about others judging them
when they told them they have sought mental health services, and over a fifth of the population,
or 21%, have even lied to avoid telling people they were seeking mental health services. This
stigma is particularly true for younger Americans, who are more likely to have worried about
others judging them when they say they have sought mental health services (i.e. 49% Gen Z vs.
40% Millennials vs. 30% Gen X vs. 20% Boomers).
Stark Disparities in Accessibility at State and Income Levels
Based on the analysis of third-party data, states are struggling to keep up with demand due to lack of
funding and facilities, and, to a lesser extent, providers. Texas, Wisconsin and Georgia ranked among the
lowest in terms of lacking adequate number of providers, facilities and funding to support the states’
populations. Pennsylvania, New York and Minnesota ranked among the top.
There is also a large disparity in access to mental health care based on level of income and location.
Individuals located in rural areas and of lower-income are less likely to say that mental health services are
extremely accessible to them.
Compared to middle- and high-income households, low-income Americans are less likely to know where
to go for treatment and more likely to use a community center verses a qualified mental health center. Of
the Americans that have not sought mental health treatment, more than half, or 53%, were in low-income
households.
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In addition, compared to Americans living in urban and suburban areas, individuals living in rural areas
are less likely to proactively seek mental health specialists they need, and instead go to their primary care
doctor or community center for treatment. Rural Americans are also less accepting of mental health
services and care.
The Path Forward
The Cohen Veterans Network and National Council for Mental Wellbeing believe that more must be done
to improve access to care for everyday Americans. Specifically, younger Americans need more
information on how and where to access care. There must also be a better understanding of the real cost
of delivering mental health care and related reimbursement rates, which typically cover only a small
portion of care. This is critical to help attract new providers into the field and more must be done to train
and retain providers to help ensure people can get help when they need it. Finally, we must ensure
standards of care are consistent through continued adoption of evidence-based practices.
For more information on the comprehensive study results and how CVN and National Council are working
to address mental wellness and accessibly across the country, please visit
www.cohenveteransnetwork.org/AmericasMentalHealth or www.TheNationalCouncil.org.
About America’s Mental Health 2018
Cohen Veterans Network and National Council for Mental Wellbeing partnered with Ketchum Analytics
who conducted an online survey among 5,000 Americans, representative of the U.S. population based on
age, gender, region, household income and race/ethnicity. The survey was conducted between July 31 –
August 12, 2018, with a margin of error of +/- 1.38 at the 95% confidence level. Through the survey, the
following groups were identified: veterans, active duty military and those with a secondary relationship
with a veteran as well as those who have sought mental health treatment (Mental Health Treatment
Seekers). A custom index was developed, ranking each state according to its mental health service
access. Third-party data was gathered to determine access based on four pillars: providers, facilities,
funding and satisfaction. Data was aggregated and averaged to each state, resulting in a score between
0 and 100, where 100 indicates the greatest access.
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About Cohen Veterans Network
The Cohen Veterans Network (CVN) is a 501(c)(3) national not-for-profit philanthropic organization for
post-9/11 veterans and their families. CVN focuses on improving mental health outcomes, with a goal to
build a network of outpatient mental health clinics for veterans and their families in high-need
communities, in which trained clinicians deliver holistic evidence-based care to treat mental health
conditions. There are currently 10 Steven A. Cohen Military Family Clinics nationwide.
About National Council for Mental Wellbeing
The National Council for Mental Wellbeing is the unifying voice of America’s health care organizations
that deliver mental health and addictions treatment and services. Together with our 2,900-member
organizations serving over 10 million adults, children and families living with mental illnesses and
addictions, the National Council is committed to all Americans having access to comprehensive, highquality care that affords every opportunity for recovery. The National Council introduced Mental Health
First Aid USA and more than one million Americans have been trained. For more information, please visit
www.TheNationalCouncil.org.
Burnout in Mental Health
Services: A Review of the
Problem and Its Remediation
Gary Morse, Ph.D., Associate Executive Director, Michelle P. Salyers, Ph.D., Research Scientist, Angela L.
Rollins, Ph.D., Research Scientist, Maria Monroe-DeVita, Ph.D., Assistant Professor, and Corey Pfahler, MSW,
Doctoral Student
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