Accessing mental health services is the biggest barrier in our community
May is Mental Health Awareness Month, which was first observed back in 1949. It is important for all of us to recognize the importance of good mental health practices and not stigmatize those with mental illnesses. Access to care is the most crucial component in any treatment plan.
Families with a child or loved one who struggles with a severe mental illness or substance use disorder know that finding the right level of care at the right time can be overwhelming.
The services are out there, but they can be hard to find and, once found, hard to access, with long wait times for therapists and psychiatrists, with some only accepting private health insurance, and with many choosing to be cash only, now, not accepting Medicaid, Medicare or Affordable Care Act exchange plans. As many people with mental illness or substance use disorder are unemployed or underemployed, they don’t have employer-based health insurance. These individuals rely heavily upon government insurance plans.
In the United States, and around the world, incidence of mental illness and substance use disorder continues to rise, with the largest percentage of initial psychotic episodes happening among young adults ages 18 to 25. If their families don’t have insurance through an employer, it can cost anywhere from $150 to $400 an hour for a private pay appointment, and from $25,000 to $75,000 a month for a residential facility.
More clinicians are needed
Illinois is trying to increase the number of licensed clinicians with a creative approach to licensure for people who have failed to pass the licensed clinical social worker exam. It’s the first state in the nation to allow an “apprenticeship” in which individuals who have completed their coursework and internship requirements but failed the exam, would be able to work for a licensed clinician and become licensed by completing 3,000 of supervised experience.
The communities most in need of services have the highest rate of failure on the exam. This plan could allow more people to work in underserved communities. We particularly need mental health workers in urban settings who reflect the diversity of our region. If we can increase access to care in those areas, it would be a very good first step.
Legislation is pending in the General Assembly that would also make it easier for an individual licensed in another state to become licensed in Illinois.
More ‘living rooms’ and peer counselors
In Illinois, the Living Room Program provides drop-in services through mental health agencies where someone who is struggling with increased symptoms of their illness or isolation can talk to a staff member in a safe environment, de-escalate and possibly avoid hospitalization. There are about two dozen of these living rooms scattered around the state, with about six in Chicagoland.
Aside from there not being enough living rooms, they’re not accessible to many people with mental illness, who often don’t drive and lack public transportation.
One of the obstacles to opening more living rooms is lack of staff, professional mental health workers and peer counselors, in Illinois known as certified recovery support specialists (CRSS). This is someone with a lived experience of mental illness or substance abuse disorder who is in recovery. Ideally, a living room has at least three CRSS staff members under the supervision of a licensed counselor or social worker.
Becoming a CRSS is not for everyone. In order to get certified, an individual with lived experience takes classes and does an internship. The College of DuPage and Elgin Community College offer CRSS programs, but these remote suburban locations aren’t accessible for many would-be support specialists. More community colleges should be required to offer this certification so peer counselors can start working where they are most needed.
Better insurance coverage
With long wait times to see a therapist or psychiatrist, and Medicaid being the most likely payer for seriously mentally folks or those with substance use disorder, the wait for treatment can be months
Private practitioners don’t accept Medicaid, only Medicare. Almost no one accepts ACA exchange policies. There are a few bills still pending in the Illinois General Assembly to improve insurance parity for behavioral health by requiring a minimum reimbursement tied to Medicare reimbursement. We have a long way to go, though, to make mental health and substance addiction care affordable for all.
This is not just a problem for individuals; it’s a problem for our society. Having been a therapeutic consultant for 10 years and worked with community mental health agencies for over 20 years before that, I interact with many community-based mental health agencies, police departments, jails, state’s attorneys, private attorneys and public defenders.
I frequently have clients who are incarcerated because they didn’t get the right level of care and committed a crime while symptomatic. The largest number of mental health beds is in our correctional system. If there were better access to care in the community, we could keep more people out of jail.
If you or a family member is dealing with mental illness or substance use disorder, take advantage of whatever services you can access, but be sure to let your state legislators know they could be doing more.
• Bonnie Lane, M.S., is principal consultant with Family Support Services in Northbrook, specializing in supporting families whose loved ones suffer from severe mental illness or substance use disorder. Contact her at (847) 651-1554 or bonnielane@thefamilysupportservices.com.