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Texas’ Mental Health Crisis: Getting the Care We Need

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By Dr. Chad Lemaire, MD

Mental illness is quite common: one in five adults in America experience a mental illness, and nearly one in 25, or more than 10 million American adults, live with a serious mental illness. Thankfully, much progress has been made in decreasing stigma in recent years; many who previously were not willing to seek help for their struggles now are. However, many are still not getting treatment. Sixty percent of adults with a mental illness received no mental-health services in the previous year, and the average delay between onset of mental-health symptoms and intervention is 8–10 years. Studies in recent years from the National Institute of Mental Health and the Child Mind Institute have shown similar numbers for children—about two-thirds with a diagnosable mental illness have not received treatment.

While stigma continues to be a significant part of the reason for these statistics, a relative lack of access to mental healthcare is certainly another. In recent years, Texas has ranked 48th or 49th in the nation for the amount it spends per person for mental healthcare.

Regarding psychiatrists, there is a national crisis brewing: nearly 60 percent of the psychiatrists in the nation are older than 55 years, many of them closer to retirement than the beginning of their careers. It is likely that the number of psychiatrists leaving the profession will be greater than the number of residents finishing their training—this coming at a time when the population is growing and demand for services is increasing.

In Texas, we have an even greater shortage. According to the American Medical Association, Texas has roughly 5.5 percent of the nation’s psychiatrists but 8.5 percent of the total population, giving us 5.7 psychiatrists per 100,000 people, below the national average of 8.9/100,000. Many experts believe that even the national average is well below what is needed. Some have called this a public-health crisis.

These challenges have led to increased efforts in the last decade to integrate care, often utilizing psychologists and therapists working alongside primary-care doctors to help provide team-based care to those with mental-health needs. At Legacy, we are working out ways to best deliver this integrated care with our primary care and behavioral health teams. Fortunately, over the last several years we have grown these teams dramatically while increasing access to care for the communities we serve.

At the same time, we look forward to ongoing efforts to increase funding for mental healthcare, as this vital care continues to prove its importance in society. A timely study released this month by the World Health Organization noted that improving mental healthcare can have a huge economic payoff—for every dollar invested in treatment programs for depression and anxiety, those programs would bring a return of $3 to $5 in recovered economic contributions and years of healthy life.

Dr. Paul Summergrad, former president of the American Psychiatric Association, astutely noted that while the economic case is a good one, “There are many other important reasons to consider enhanced investment in global mental health, not least of which are justice, equity, human rights, and the reduction of suffering.”

At Legacy, we believe that access to great healthcare, including mental healthcare, is a human right, and we continue to work to improve access for those who so desperately need it.

Dr. Chad Lemaire, MD, is the medical director of behavioral health at Legacy Community Health.

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