Episode 4: Depression and the Healthcare System

Nothing in this post is intended to be taken as medical advice. We do not offer medical advice. If you or someone you know needs help, scroll to the bottom of this page for links to important depression and mental health resources, and contact a healthcare provider.

CHAPTER 11: THE OVERLOAD

Sifuentes’ experience missing therapy sessions leading to insurance no longer paying for it
How the system approaches mental and physical health differently
The overloaded mental health care system and the shortage of providers
Full conversation with Lorenzo Lorenzo-Luaces:
Full conversation with Rachael Massell:
Full conversation with Mary Carter:
An introduction to Jameson Norton
Full Conversation with Jameson Norton:
The challenges of the hospital administrator in dealing with systemic issues
Systemic difficulties faced by the insurance industry determining patient needs
Full conversation with Jameson Norton:

CHAPTER 12: GLOBAL ECONOMICS AND ITS PERSONAL RELEVANCE

The economic consequences of mental health
Introduction to Janet Currie
Full Conversation with Janet Currie:
Introduction to Denise Razzouk
Full Conversation with Denise Razzouk (note that we got cut off from Denise as we were wrapping up so the audio ends abruptly):
Global society’s failure to recognize or deal with the scope of the issue

CHAPTER 13: POLICY; AND PARITY IN PRACTICE

CHIP as a key policy for mental health care
An introduction to the mental health parity law
Limitations and deficiencies of federal policies
A startup insurance company’s perspective – Oscar Health
Full Conversation with Vin Mitta:
Enforcement, or lack thereof, of mental health parity – a comment from CMS

CHAPTER 14: SOME SOLUTIONS FOR THE SYSTEM

PEOPLE

Caroline Leland – Freelance Journalist; Contributing Factors Host & Producer
Lucero Sifuentes – Individual living with Major Depressive Disorder
Lorenzo Lorenzo-Luaces – Assistant Professor, Indiana University Bloomington
Rachael Massell – Psychotherapist, Independent Practitioner
Janet Currie – Henry Putnam Professor of Economics and Public Affairs, Princeton University; Director, Princeton Center for Health and Wellbeing
Denise Razzouk – Author, Mental Health Economics; Head of the Discipline of Psychiatry, Universidade Metropolitana de Santos
Mary Carter – Psychiatric Nurse Practitioner, The Renfrew Center
Jameson Norton – CEO, Vanderbilt Psychiatric Hospital and Clinics; Executive Director, Vanderbilt Behavioral Health
Vin Mitta – Vice President of Clinical Operations, Oscar Health

LINKS

“Only half the patients with a threshold disorder are recognized and then only half of those are recognized or treated. Only half of those are treated are treated effectively.” -Jameson Norton, CEO, Vanderbilt Hospital and Clinics

Why Mental Health Care is Key to Population Management (Health IT Analytics)

“Types of Information Physicians Provide when Prescribing Antidepressants” -J Gen Intern Med study by Young, Bell, Epstein, Feldman, and Kravitz

Mental Health and Money

The annual economic cost of MDD in the United States alone is a staggering US$70 billion in medical expenditure, lost productivity and other costs.

Depression costs 1 trillion dollars a year globally via loss of productivity. By 2030, the cost of mental disorders will grow to $6 trillion from its current $2.5 trillion dollars.

Mental Health Economics (book by Denise Razzouk, 2017)
“The economic burden of depression in 1990” -J Clin Psychiatry study by Greenberg, Stiglin, Finkelstein, and Berndt
“The economic burden of depression and the cost-effectiveness of treatment.” -Int J Methods Psychiatr Res study by Philip, Gregory, and Ronald

Some insurers don’t reimburse mental health providers well — which makes it harder for those providers to be able to afford treating uninsured patients, or to provide sufficient services to their existing patients, or to take on new patients. As a result, many psychiatrists and other mental health professionals decide not to accept many kinds of insurance, so people with health insurance often struggle to find an in-network provider.

Not White, Not Rich, and Seeking Therapy (The Atlantic, 2016)
“Acceptance of insurance by psychiatrists and the implications for access to mental health care” -JAMA Psychiatry study by Bishop, Press, Keyhani, and Pincus

In 2015, insurance companies reimbursed mental health professionals 83 cents to every dollar that primary care doctors were reimbursed — and this held true even when those providers were treating the same condition, like depression.

When It Comes to Insurance Money, Mental Health Is Not Treated Equal (Marketplace, 2018)

Health insurance is more likely to cover post-diagnosis treatment than any kind of proactive mental health protections.

Why I Had to Close My Preventative Healthcare Clinic (The Atlantic, 2014)

CHIP Is Beloved. Why Is Its Funding In Danger? (The New York Times, 2017)

Affordable Care Act

Supporters of the ACA emphasize the law’s role in protecting patients with pre-existing conditions, including mental health conditions. An October 2017 executive order from President Trump gave states new ways to get around those requirements.

The Stealth Repeal of Obamacare (Politico, 2017)

In the 18 states that have not accepted the expansion, adults that fall into a certain income range (below the federal poverty line but with income above 44% of the poverty line) end up without coverage.