One of the biggest challenges to the provision of behavioral health is the fact that most of the services and care are provided in primary settings, and not in specialty programs. Despite various factors such as education, practice guidelines and other forms of training, research indicates that primary care practitioners underdiagnose depression, substance abuse and other forms of behavioral health sciences. The Institute of Medicine has further ratified this report and indicate that indeed underdiagnoses is a problem in primary care settings. While this is changing, there is increased need to increase the capacity of healthcare service providers and coordinate the activities of the same. As well, there is continuing need to ensure that care provided at specialty care is closely coordinated. These approaches will reduce the prospects of underdiagnoses and misdiagnoses that has been reported in these areas. In the same perspective, the public health care system for individuals suffering from some of the most disabling conditions transcends beyond health care services to other forms of rehabilitative care and support such as consulting, literacy programs, and job services. Various governmental, non-governmental and other agencies should ensure such efforts are closely coordinated to achieve superior outcomes. Unfortunately, these services or packages are not provided by private and public insurance agencies.
Even though mental health problem is pervasive in various segments of the contemporary society, and especially in modern America, there have been plans to underestimate the scope of the problem. Bartlett and Hollins (2018) note that one of the factors to underestimating the problem results from stigma; most people diagnosed with mental health problems, and by extension, their accomplices, face various forms of social stigma in their prospects of getting care. The relatives mask the problem by keeping it in the closet. These prospects have hampered response and treatment efforts by various agencies. The prospect of underestimating the problem is even prevalent in the health insurance and coverage. Bartlett and Hollins (2018) note that unlike other health problems, distinct publicly managed health care systems are available for mental illness and treatment to substance abuse. In most of the insurance systems, mental health and other forms of behavioral concerns are not included in their scope of care and services. This situation is caused by the fragmentation that exists between federal, state, and local government entities that allow insurance companies to get away with such behaviors. In turn, the public sector system is left with a huge role of caring for people with pervasive behavioral health challenges, such as people with histories of chronic mental challenges such as alcoholism, and chronic drug dependence. This is straining to the public system. For instance, a 2014 report estimated that the cost for caring for mental health care in the U.S. stood at $900 billion, money drawn from the public health care system and governmental coffers (Clifton & Thorley, 2014).
In several states across the U.S., Medicaid has been the sole financier of mental health care for community health programs. In fact, estimates indicate that Medicaid supports more than a third of all the community mental health clinics and programs as well as rehabilitation centers across the U.S. Other forms of support are provided by various state mental health agencies and third service providers. Thus, the public health system plays an integral role as compared to other health service providers. However, there is a fragmented division of labor between the public health system and the private sectors. This situation has often made the process of estimating the cost for behavioral healthcare straining. Partially, this fragmented system has been considered as a principal reason for the high indirect costs associated with caring for mental disorders.
Clifton and Thorley (2014) specifically note that some of the costs associated with caring for people suffering from behavioral disorders, more particularly for patients with greatest disabilities in the public domains, are not even related to healthcare. For instance, in some circumstances, these individuals require forms of help such as housing, job supports training, forms of rehabilitation, and a myriad of healthcare services normally not contained in insurance packages. Due to the fact that there are various forms of disability associated with serious mental health and substance abuse problems and the inconsistent private insurance to these people, most of the individuals suffering from mental health often lose jobs. In so doing, these people are forced to seek income maintenance benefits. Since these benefits are considered as social costs, they are not considered in a tally of the total costs of care. Other researchers have further affirmed that higher rates of mortality, disability, and loss of employment are some of the principal problems related to behavioral problems. Thus, societal costs resulting from behavioral health problems principally results from lost productivity and other related costs but not due to treatment.
Additionally, the public perception of forms of behavioral conditions, inclusive of mental healthcare is another factor that has negatively affected the care process. In an article by Sabella and Fay-Hillier (2013), the public considers people with mental healthcare as irrational, inconsiderate, and outcasts that should be locked up in some secluded places for public safety. People with mental health issues are often ridiculed, shunned and even feared for the obvious known reason that they could be unruly. In some reported cases, people suffering from mental problems have been burnt to death. While there have been improvements in the type of care accorded to such patients, and victims are no longer exposed to straitjackets, lobotomies, restraints, and station, the public approval of the victims continues to be low. Such forms of shunning treatment stem from the medieval culture where people with unstable mental conditions were kept in secluded places for public safety.
Overall, the behavioral system faces some concerns. For instance, the funding of behavioral care is fragmented. Insurers have failed to provide comprehensive insurance for people suffering from unstable behavioral health concerns. Similarly, there is a negative public perception of people who have mental illness.
