We repeatedly hear warnings about the looming shortage of doctors, a crisis intensifying by 2014 when reform provisions allow 30 million people who now lack health insurance to afford medical care.
But who is paying attention to whether there will be enough specialists in behavioral or mental health to treat them all?
Emergency room doctors, primary care and family medicine caregivers are often the first to encounter behavioral or mental disturbances in their patients, but will they have enough training to recognize what they see, and what to do, especially when so many people who have gone so long without mental health care begin to seek it?
Additionally, health plans for the insured will be required to cover mental illness care just as they do now for physical illness under the Patient Protection and Affordable Care Act's "mental health services parity" provisions. Prior behavioral problems will no longer be reasons for exclusion.
All these factors "will stretch the health professions to levels we haven't ever seen," says Sergio Aguilar-Gaxiola, a professor of clinical internal medicine at UC Davis Medical Center Health System and a community psychologist. "We don't have enough primary care providers to deal with what I call a tsunami of newly needed services for those 30 million newly insured."
As anyone who has ever worked in a hospital or clinic knows, mental illness—frequently exacerbated by cycles of drug or alcohol abuse and homelessness—is often a subtle, underlying problem in a large segment of their patient mix. That's especially true in larger inner city settings, but it is also true—perhaps to a lesser extent—everywhere else. It takes a degree of skill to recognize it.
Aguilar-Gaxiola is a co-author of a survey report from the UCLA Center for Health Policy Research that quantifies how bad the problem may truly be.
One in five adults surveyed said they had needed professional help for a mental or emotional problem within 12 months of the survey. And one in 25 reported one or more symptoms associated with serious psychological distress, based on the number of times in the last 30 days they felt nervous, hopeless, restless or fidgety, worthless, so depressed that nothing could cheer them and that everything was an effort.
The report is drawn from the California Health Interview Survey, the largest state health questionnaire in the nation. The survey was conducted by the UCLA Center for Health Policy Research, which collected health related responses through telephone interviews from nearly 50,000 adults in the state, a process undertaken every two years.
Extrapolating the findings to California as a whole, the researchers discovered that 4.9 million California adults said they needed help for a mental or emotional health problem in the last year and one million reported symptoms associated with serious psychological distress in the last 30 days.