People who work in the mental health field have long been concerned about access to treatment, as well as parity in insurance coverage for mental health care. Legislation in Congress and discussion on the presidential campaign trail is bringing renewed attention to the issue, according to Dr. Harsh K. Trivedi, president and chief executive officer of the Sheppard Pratt Health System.

How many people suffer from a mental health disorder, and how many are estimated to go without treatment?


More than 40 million Americans and close to 17 million children live with some form of mental illness — that's nearly 1 in 5 adults and 1 in 5 children ages 13-18. To put this in perspective, a little over 29 million Americans have diabetes, and 27.6 million have heart disease. What's worse, while treatment is available and does work, nearly two-thirds of those affected never receive care.

Untreated mental illness costs the country at least $444 billion a year. And only about one-third of that total goes to psychiatric care, as the bulk of the cost to society stems from disability payments and lost productivity.

What are the main hurdles to care?

One major hurdle to seeking care is the stigma surrounding mental illness. Many people fear judgment or discrimination from family, community members and employers if they disclose that they suffer from a mental illness. This can create a barrier that keeps them from seeking treatment.

Lack of adequate health insurance and difficulty of finding an in-network provider who has appointment availability are two other barriers to care. Even for those with insurance, many patients have significant out-of-pocket costs, and some insurance plans only cover limited options. Plus antiquated Medicaid and Medicare policies limit funding for inpatient psychiatric care for some of our most vulnerable.

Have there been steps in improving parity in treating mental health ailments?

This is a promising time for mental health care reform. In July, the House of Representatives passed the Helping Families in Mental Health Crisis Act — and we are hopeful that the Senate will pass this bill into law by the end of the year. In the Senate, the Mental Health Reform Act of 2016 is still active as well.

Together, the passage of these bills would offer key improvements to our mental health system. These include necessary structural changes, such as clinician leadership across federal departments and agencies to ensure the best scientific approaches to treating mental illness, as well as new efforts to address shortages of mental health practitioners across the country. These reforms would also strengthen enforcement of the Mental Health Parity and Addiction Equity Act, and provide much needed funding for innovative models of care meant to treat those suffering from long-term, debilitating mental illnesses.

What has been proposed on the presidential campaign trail, and how might it help?

Hillary Clinton's proposed mental health policy is the first time a candidate has attempted to look at the continuum of care for mental health. Key initiatives of Clinton's plan include early diagnosis and intervention; a national initiative for suicide prevention; enhanced community-based treatment opportunities; training for law enforcement in crisis intervention; improving access to job and housing opportunities; and investments in brain and behavioral research. These initiatives are long-overdue steps that must be taken as part of a comprehensive strategy to defeat stigma around mental illness and improve health care for all.

[Republican presidential nominee Donald Trump also has called for mental health reform but has not offered specifics.]

What needs to happen to draw more attention and resources to the problem?

We need to begin placing mental health treatment on the same level as physical health care in this country. It is time for us to take mental illness as seriously as we would cancer or heart disease. We, as a society, would never deny someone the ability to receive treatment for cancer or heart disease. However, many of our most vulnerable encounter difficulties accessing mental health care on a daily basis.

We need to provide training to our communities so that we can help educators, school nurses, law enforcement and others to recognize the early signs of psychiatric problems and refer people to the appropriate help when needed. We need to expand access to care through telemedicine and access to high quality mental health facilities.


Finally, we need to talk about mental health and substance use, and reduce the negative perceptions of mental illness. We need to share stories and fight stigma so that we encourage people experiencing mental health problems to reach out for help. As the largest non-profit provider of mental health services in the country, we at Sheppard Pratt Health System work hard every day to improve the quality of life of those with mental health and substance-use issues.