Part 1 of 6 | May 31, 2024

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RESOLUTION C-8: EXPANDED ACCESS TO MENTAL HEALTH SERVICES
Authors: M. Mayes DuBose, SCMA President-Elect, Frank Clark, MD for SCPA, Patricia Bouknight, MD for SCAFP and Elizabeth Mack, MD for SCAAP

“RESOLVED; that the SCMA will work with South Carolina agencies, payors, healthcare systems, the Governor, and the General Assembly, where appropriate, to advocate for expanded access and increased coverage and payments for mental health services provided by physicians.”

I am deeply honored to be the 163rd President of the SCMA and this resolution, passed last month at our annual House of Delegates, will be my platform. The combined support of Dr. Clark and the SCPA, Dr. Bouknight and the SCAFP, and Dr. Mack and the SCAAP is reflective of the fact that mental health care should be an “all hands on deck” endeavor for those of us in primary care, but ideally across all of medicine.

My training is in both Family Medicine and Geriatric Medicine and I am passionate about primary care. I am also proud to be an independent physician in an “autonomous practice” (to use Dr. Spence Taylor’s term). I am not advocating for the unrealistic goal of a completely autonomous physician workforce, but I do believe our profession’s diminishing level of autonomy has affected nearly every facet of what we do.

Poor access to and poor reimbursement for mental health services are prime examples of payors and increasingly depersonalized health care systems affecting what we as physicians know is a core tenet of the health of our patients, as well as our own. In 2021, nearly 38% of South Carolina adults reported symptoms of depression and anxiety, but an estimated 220,000 did not receive mental health care and just less than half stated cost as the reason. 53,000 of our residents aged 12-17 have been diagnosed with depression and over half of them received no mental health care at all. South Carolinians are nearly 5 times more likely to be pushed out-of-network for mental health care than for primary care.

We all know the downstream consequences of inaccessible and inadequately funded mental health care and are currently bearing witness to them in our modern society: increased ER visits, higher healthcare costs due to inadequately managed chronic conditions, heavier burdens on law enforcement and EMS, increased homelessness and incarceration, and worsened substance abuse disorders and suicide rates.

Over my series of newsletters this year, I would like to systematically address this broad and multifaceted topic. I plan to discuss innovative ways technology can aid mental health services, how this can be integrated in primary care practices, as well as how we should continue to address mental health wellness not just for our patients, but also for ourselves and our coworkers. I am proud to serve as your president and this will be my platform as I work with our SCMA colleagues in order to enact meaningful change in this area for the good of all South Carolinians.

 

References:

• National Alliance on Mental Illness. Mental health by the numbers. Updated April 2023. https://www.nami.org/mhstats
• Cunningham PJ. Beyond parity: primary care physicians’ perspectives on access to mental health care. Health Aff (Millwood). 2009;28(3):w490-w501.