According to the Centers for Disease Control, Florida had rates of anxiety and/or depression of 30.1% at the end of September 2023 compared to the national rate of 28.7% but ranked 49th in the nation on access to care. An analysis by the Kaiser Family Foundation published this year reported that in September 2022, 509 mental health providers would be needed to fill this void.
When primary care providers (PCPs) talk to patients about their health, the focus is usually on the physical issues. Mental health is often completely neglected or given a small amount of attention in the form of a two-question survey. There is a disconnect between the enormity of the mental health burden in the United States and the availability of treatment.
Those suffering from mental health conditions are left floundering to navigate the confusing, convoluted world of trying to find help. When my teenage daughter was suffering a mental health crisis, I would not have been able to find care without my knowledge of this system. Others are not so fortunate.
If the paucity of mental health professionals wasn’t an enormous concern, then there is the cost. Too often, patients tell me they want to get help but simply can’t afford it. What’s worse is the lack of insurance coverage for these services. When services are out of pocket, this makes them unaffordable to a vast majority of people.
Senate Bill 2500, effective July 1, 2023, will provide $2.5 billion in funding for mental health and substance abuse programs, most of which is going toward a rate increase for Medicaid behavioral health providers. But as of April 1, 2023, about a million Floridians will be in danger of losing their Medicaid over the next 12 months thanks to the 2023 Consolidated Appropriations Act, which decoupled continuous coverage through the COVID pandemic, even for those who were no longer eligible.
It seems the extra funding would be moot if one in five Floridians potentially lose Medicaid. The funding from SB 2500 could instead be appropriated to educate primary care providers on how to administer screening psychiatric tests and manage these conditions. Extra training could increase the accessibility of mental health services to patients.
Although PCPs are already overwhelmed, they are the constant in the patient care continuum. The benefits of using PCPs to screen for mental health conditions are lower copays and an already well-established relationship. Patients may have a higher level of trust, making conversations about mental health more open and honest.
Only about half of mental health professionals accept insurance. Even if there are miraculously 500 more providers available in Florida, as the Kaiser Family Foundation found we need, most people needing care would still be unable to afford it.
Expanding the role of the PCP by incorporating mental health screenings beyond the basics would greatly increase access to care. I implore all my fellow colleagues to contact your state representative to request that next year’s state budget include continuing education funds for advanced mental health training courses for health care providers.
Selina Kozan is a family nurse practitioner in West Palm Beach.