Excising our internal anxieties is an essential aspect of
wellness. Relief from internal strife and stress is a key component for health.
In The Lancet’s published study on all-cause-loss-of-years-of-life attributable
to mental illness, men were found to have lost fifteen years and women,
thirteen. To arrive at these conclusions, the researchers analyzed 35,865
studies and found 109 which were similar for inclusion in their meta-analysis
of 12,171,909 patients with mental disorders. (Joe Kwun Nam Chan, 2023) This is a type of statistical
analysis called meta-analysis, where high quality studies which are similar in
hypothesis and population, are analyzed to find a pattern and to draw conclusions
on the study findings from a much larger population sample. Conclusions from
meta-analysis studies are very valuable for health policy planning and funding
for interventions in public health. Statistically when the studies are of high
quality, with confidence intervals in the 90th percentile and
represent a larger population, the findings are more reliable than smaller
studies for informing systemic changes in healthcare. A confidence interval is
a statistical measure to determine the likelihood of the same result being
generated using similar data. It is a validator for the quality of the study
methods and analysis. What makes the conclusions so urgent is even a benign
diagnosis of anxiety or neurosis showed a reduction in life expectancy of eight
years. It was no surprise the study found those suffering from substance abuse
disorders had a reduction in life expectancy of twenty years. People with
eating disorders were found to have a loss of sixteen years in life expectancy.
Intriguingly those suffering from schizophrenia showed fewer years of lost life
than the eating disorder group. Please note this study was only for patients
seeking treatment, when untreated mental illness is a global problem and some
would say crisis.
Youth Suicide
The United States has one of the highest youth suicide rates
in the industrialized world with 11.5 deaths per 100,00 persons between the
ages of 19 and 24, second only to Australia and tailed by Canada. (Cristopher Doran, 2020) The National Institutes
of Health study on global youth suicides found that for youths between nineteen
and fifteen years, the mean suicide rate was 7.4 deaths per 100,000. In other
words, the rate of youth suicide in the U.S. is 35% higher than the rate elsewhere
in the world. Males showed much higher suicide rates at 10.5 to females of 4.1
per 100,000 of their peers. This study reviewed data from ninety countries and alarmingly
found the suicide rate for females was increasing and the overall suicide rate
for men and women was also increasing, except in Europe. Information was drawn
from the World Health Organization Mortality database. (DANUTA
WASSERMAN, 2005)
Young people killing themselves is a public health crisis of immense
proportions and is indicative of poor primary care, the limited availability of
qualified mental health clinicians, and the lack of funding for adequate
treatment.
The point is what you spend your time thinking about and how
that impacts your nervous, circulatory, and immune systems are indelibly
linked. Thankfully, there are many more tools today to help people redirect
their thoughts and make changes in negative practices. Virtual therapy allows
those in rural areas to access high quality therapy, as well as busy working parents
to be able to do it from their home or office. The advent of smart phones means
many more people in the world have access to the internet and this is
empowerment. Health and Human Services has invested thirty-five million dollars
in expanding community mental health services and suicide prevention. (Substance Abuse and Mental Health Services
Administration, 2022) The total mandatory spending for healthcare
in the United States Budget for 2024, which was approved on March 23rd,
designated 4.2 trillion in mandatory allocations and 1.9 trillion for
discretionary programs like this. As you can see, the amount mental health
services are receiving in the federal budget allocation is tiny compared to the
overall investment.
US Government Investment in Targeted Mental Health Services-2024 Budget
Currently, there are three federal government initiatives to
increase access to care for mental health services: shared Savings Programs through
the Accountable Care Organizations (Health & Human Services, Centers for Medicare
and Medicaid, 2012), targeted funds for health care in
rural America, and the expansion of state Medicaid programs which decrease the
likelihood of rural hospitals closing by half. (United States
Department of Health and Human Services, 20232) The Accountable Care
Act was created in 2010, along with the Accountable Care Organization Shared Savings
Program and has been instrumental in creating financial rewards for health care
organizations to target key health outcome criteria, based on evidence-based
planning and medical research. Though the expansion of Medicaid under the
Affordable Care Act was good for increasing the number of people whom can
obtain affordable medical insurance, it did little to increase access to the availability
of mental health services, as most mental health practitioners do not accept
the Medicaid reimbursement level. Under the Accountable Care Act, which is
administered by the Centers for Medicare and Medicaid, as of January 2024 there
is additional funding allocated for rural hospitals to help them obtain advance
payments to fund mental health workers. The Biden-Harris Administration
allocated twenty-eight million in direct funding for health care for rural entities
and another sixteen million for technical support in the 2024 budget. (United States Department of Health and Human
Services, 20232)
The goal is to expand the rural health care workforce and increase access to
care for the sixty million people who live in rural areas. However, the
implementation of these programs will be determined after the 2024 presidential
election. We can only hope this is
supported by both parties.
And this is the healthpolicymaven signing off encouraging
you not to sign blanket releases when you agree to medical procedures, do
stipulate that to which you agree and decline.
This column does not purport to give medical advice and all
opinions are those of Roberta Winter, an independent healthcare analyst and
journalist who accepted no reimbursement for its contents.
References
Cristopher Doran, I. K. (2020, May 19). Economic and
epidemiological impact of youth suicide in countries with the highest human
development index. PLOS One. PLOS One.org. doi:https://doi.org/10.1371/journal.pone.0232940
DANUTA WASSERMAN, 1. Q.-X. (2005, June 4). Global
suicide rates among young people aged 15-19. World Psychiatry(June 4
(2) 114-120). World Health Organization. doi:PMID: 16633527
Health & Human Services, Centers for Medicare and
Medicaid. (2012, April 10). First Accountable Care Organizations Under the
Medicare Shared Savings Program. CMS.gov. Retrieved June 1, 2024, from
https://www.cms.gov/newsroom/fact-sheets/first-accountable-care-organizations-under-medicare-shared-savings-program
Joe Kwun Nam Chan, a. C. (2023, October 31). Life
expectancy and years of potential life lost in people with mental disorders: a
systematic review and meta-analysis. The Lancet.com, Volume 65. London,
England/United Kingdom. doi:https://doi.org/10.1016/j.eclinm.2023.102294
Substance Abuse and Mental Health Services
Administration. (2022, May 9). HHS Announces Nearly $35 Million To Strengthen
Mental Health Support for Children and Young Adults. SAMSA.gov Press
Release. United States. Retrieved May 27, 2024, from
https://www.samhsa.gov/newsroom/press-announcements/20220309/hhs-announces-35-million-strengthen-mental-health
United States Department of Health and Human
Services. (20232, November 3). The Biden-Harris Administration is taking
actions to improve the health of rural communities and help rural health care
providers stay open. Health & Human Services News. Washington,
District of Columia, United States. Retrieved May 30, 2024, from
https://www.hhs.gov/about/news/2023/11/03/department-health-human-services-actions-support-rural-america-rural-health-care-providers.html
