Mental Health in Arkansas: Access, Societal Costs and Parity

Elizabeth Caldwell

Mental Health in Arkansas

Mental disorders are common throughout Arkansas, the United States and the world. They affect people of any age, race or religion, according to the National Alliance on Mental Illness (NAMI).

mental-distress-calloutIn Arkansas, 12.5 percent of the population reported having frequent mental distress in 2010 compared to 10.7 nationally, according to the Centers for Disease Control and Prevention.

The rate was higher for Arkansas women (14 percent) than Arkansas men (11 percent). Arkansans ages 25-34 reported the highest rate at 14.7 percent compared to 6.2 percent of those 75 and above.

Mental health professionals know these disorders are not caused by poor upbringing, personal weakness, or lack of character, but are biological medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and ability to function.

In the United States, about 26.2 percent of those ages 18 and older have a diagnosable mental disorder, though a much smaller number — about 6 percent of the total population — has a serious mental illness, according to the National Institute on Mental Health (NIMH).

90percent-calloutDepression is the leading cause of disability for adults, beating out heart disease, cancer and stroke. The NIMH says more than 90 percent of people who commit suicide have a diagnosable mental disorder. In 2010, the latest statistics available, Arkansas’s suicide rate was 15.3 per 100,000 people, ranking high among southern states, according to the American Foundation for Suicide Prevention.

Some other statistics from the NIMH:

  • Major depressive disorder affects about 14.8 million, or 6.7 percent of American adults. It is more prevalent in women than men.
  • Chronic, mild depression affects about 3.3 million, or 1.5 percent of adults.
  • suicide-calloutAnxiety disorders, which include panic, obsessive-compulsive, post-traumatic stress and generalized anxiety disorders, as well as phobias, affect about 40 million or 18.1 percent of adults.
  • Bipolar disorder affects about 5.7 million, or 2.6 percent of adults, while about 2.4 million, or 1.1 percent of adults, have schizophrenia.

Insufficient Access

While many disorders can be treated, help is not always available for many reasons, said Justin Hunt, M.D., an assistant professor of psychiatry in the UAMS College of Medicine, who has completed a prestigious Robert Wood Johnson fellowship in health policy at the University of Michigan.

insurance-calloutBesides there being a shortage of mental health professionals nationwide, they are not distributed evenly throughout the country, with » many psychiatrists and psychologists often being concentrated on the urban East and West Coasts.

The ones who do practice in Arkansas are located mainly in the urban areas, particularly Little Rock, leaving the rural parts of the state largely without access. “It’s really based on geography,” Hunt said. ”We have a significant shortage in many rural regions.”

Money is another reason, he said. One in four Arkansas adults doesn’t have health insurance, and not all policies have covered mental health well. Many policies have high deductibles. With many private insurance plans paying less for services and requiring increased regulation, some psychiatrists and psychologists have gone to reimbursement on a cash basis, he said.

“You can imagine how this has a negative effect on access for folks who don’t have cash laying around to spend on mental distress.”

Geography also plays a part in who seeks mental health services. There is more of a stigma associated with mental illness in the South as well as a tendency to think it may be a spiritual or moral problem.

“People often tend to turn to spiritual support, which is wonderful and can be a very a productive thing when it comes to mental health, but church can’t resolve an acute psychotic or manic episode,” Hunt said.

telemedicine-calloutWith a shortage of psychiatrists, psychologists and licensed mental health professionals, telemedicine is a way to reach more people with fewer resources. For instance, Hunt holds a VA telemental health clinic in Russellville once a week from his North Little Rock office an hour away, and UAMS hopes to develop more telemental health services to the underserved civilian population in rural areas.

“It’s just as good as face to face in a lot of ways and data support this,” Hunt said. “It represents a clear strategic approach to serve people in rural areas.”

Homeless man

Societal Costs of Mental Illness

The cost of mental illness is borne by society as well as the individual. The absence of sufficient mental health infrastructure leads to more homelessness and incarceration, Hunt said. With the crusade in the 1960s and 1970s to close mental institutions and move toward community mental health services, a lot of people with chronic mental illness fell through the cracks.

Community mental health services were underfunded and thus ineffective in handling all needs.

“The jails and the streets have become our de facto inpatient mental health institutions,” Hunt said.

Another mental health social policy issue starts long before adulthood. Children living in neighborhoods with chronic violence or in a home highly disrupted by abuse or neglect often have increased stress responses and a decreased ability to manage stress later in life.

Brain-based neuroscience has shown the development of the cortex is often different than for someone raised in a loving, supportive household, he said, and later decision-making and impulse control can be negatively affected.

“We know that early childhood trauma has a huge impact on someone’s lifelong trajectory for mental illness,” Hunt said.

Mental Health Parity

With the Mental Health Parity and Addiction Equity Act of 2008, health insurance plans must provide the same or equal benefits for certain mental health conditions that it offers for physical conditions and at the same co-payments, deductibles and maximum lifetime benefits.

While this gives patients more accessibility to insurance for mental health, it doesn’t fix the problem of not having enough providers accepting insurance, Hunt said. Also, some policies have pretty significant deductibles that can still present a barrier to people with low incomes.

“We are concerned people won’t want to spend their cash on the front end for mental health unless something serious happens, such as becoming suicidal and ending up in the emergency room,” Hunt said.

Children and Adolescents

clock-calloutWhile Arkansas has some tough problems to deal with concerning the adult mentally ill, the state has made significant progress in treating children and adolescents, Hunt said.

A significant portion of the state’s $4 billion to $5 billion Medicaid budget goes to treating children and adolescents with mental health conditions from attention deficit hyperactivity disorder to depression to anxiety.

“Arkansas has done a good job of covering its children and adolescents through Medicaid and the State Children’s Health Insurance Program,” Hunt said. “And, the state is now moving forward with behavioral system reforms that will ensure a more coordinated system for both children and adults.”

Boy on a bike