On June 09, 2018, I was honored to make another guest appearance on Captain Bob Abbott’s radio show, Coming Home Well, in Charlottesville, Virginia. We discussed stigma in mental health in the civilian and military sectors. Our discussion was timely based on the tragic and preventable suicides of both Kate Spade and Anthony Bourdain both in the week preceding our discussion. We spoke of 45,000 suicides that occur int he US every year and how to prevent them. Other important topics included how we as a society help those suffering from suicidal thoughts and mental illness. Based on my research prior to our discussion was the important finding that people are four to six times more likely to seek mental health services out of network than they do when seeking healthcare for their physical problems. The cause for going out of network is that quality mental health providers do not accept insurance because they cannot afford to run a practice accepting mental health insurance rates. Despite the Mental Health Parity and Addiction Equity Act passed 10 years ago, mental health providers’s rates of reimbursement are less than the same mental health services provided by family practitioners. This results in people seeking medication from their primary care doctor and then never following up with a psychiatrist or psychologist for additional care, or never seeking adequate care. Based on these low rates of reimbursement, there is a dearth of competent providers available, and those that are competent and skilled (outside of hospital systems) don’t accept the rates of reimbursement resulting in few patients being able to afford quality care as they have to now pay out of pocket to see these providers. We experienced this dilemma in our own practice when Tricare moved from Value Options to Wisconsin Physicians Service this year. Our already low rates of reimbursement were reduced from 25 to 35% and then the patients’ co-pays increased significantly. Tricare is doing a disservice to its beneficiaries. For instance, a copay moved from $12 to $41 dollars for an initial evaluation for many Tricare beneficiaries. This is a significant cost jump for an E-3 and their family member. Soon a Tricare beneficiary won’t be able to afford quality care outside of the MTF.
Other important facts related to this discussion:
The past Veteran’s Care Program was a bust regarding mental health. Providers had to be Medicare providers to join the program further restricting access (who in the heck wants to be a Medicare provider and deal with an entirely different bureaucratic mess…good deeds do not go unpunished), and patients had to be unable to get a VA appointment within 30 days. What a ridiculous requirement. Many suicidal patients would be dead if they had to wait more than a few days for an appointment.
The rates of suicide seem to be climbing according to the CDC. Women, both in the military and in the civilian sector, have seen the highest rise in rates.
The rate for civilian suicide is 25 per 100,000 each year while the military rate is 35.6 per 100, 000 (2016)
Those vets with TBI are twice as likely to have PTSD and the onset of PTSD usually occurs 3-4 months after returning home.
1/3 of OEF and OIF vets have symptoms of mental health problems and cognitive problems.
1/100 of male and 1/4 of female vets have Military Sexual Trauma (MST).
The military rates of PTSD are 15 times higher than for civilians.
The military rates of depression are five times higher than for civilians.
Regarding stigma, we must use a community approach. If you see something, say something. We are all battle buddies in this life, and we all need to take care of one another. Take suicidal threats or behavioral changes seriously!