Meeting the Mental Health Needs of Patients With Chronic Medical Illness: A Crisis in Access

In order to effect change in our current health care system, it is critical to educate and enlist the support of policy makers, insurers, health professionals (both mental health and non–mental health), advocates from other chronic illness organizations (eg, those working with cancer or diabetes), and suitable corporations to ensure that mental health care is easily accessed by people with mental and physical comorbidities.

In addition to the hurdles mounted by current private insurers, Medicaid, and Medicare, there are several other challenges that must be met for an advocacy effort to succeed:

• Convincing advocates for groups with chronic physical illnesses that access to mental health care is an issue on which they should focus their time and resources.
• Overcoming the perceived stigma associated with mental health conditions—for both patients and policy makers—that is perpetuated through the media.
• Convincing public payers and private insurers of the importance of providing mental health and psychosocial care as a stated benefit for patients with co-occurring illness.
• Providing access to treatment and services when mental health care benefits vary by insurer and, in public plans, by state.
• Finding available federal and state government resources during the current fiscal crunch.

The Academy of Psychosomatic Medicine (APM) and the American Psychiatric Association (APA) Council on Psychosomatic Medicine have begun to develop a plan aimed at addressing these basic issues (Table). The plan includes development of an advocacy strategy that incorporates patient and family groups, testing of perceptions regarding psychosomatic medicine and reimbursement among policy makers and other decision makers, and development of a legislative and regulatory plan to help improve reimbursement.

In addition, others have begun to work successfully on the local level to restructure benefit plans so that mental health and physical health care reimbursements are integrated. The APM and APA’s attempt to prioritize and highlight a research agenda and create appropriate guidelines and opportunities for training will promote advances in psychosomatic medicine, address the issue of training, and ensure that there are adequate numbers of appropriately trained professionals to provide this care.

Access to psychosocial care and adequate reimbursement are essential components of quality care. We must recognize that delivery of evidencebased quality care can only be achieved when access and reimbursement are secured, and we must demand that care. The IOM has proposed that 21st century health care treatment must be safe and effective (evidence-based), patientcentered (responsive to needs), timely, efficient, and equitable.10 It also must address patients’ physical and mental health needs in order to be truly quality care.