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Okay, seriously…how is it possible that suicide numbers dropped during the pandemic?

We may be close to the end of the COVID-19 pandemic, but the scars of this battle will remain with society for a long, long time. Among the more devastating damages of COVID-19 have been the toll on mental health, with increasing signs of mental illness, greater addiction rates, increased use of mental health resources…

…and a decline in suicides…

Wait, what?

Yeah. I don’t get it either. But, according to preliminary data, suicides went down in 2020:

 From 2019 to 2020, deaths by suicide declined by 5.6%, from 47,511 to 44,834, per the CDC. It was the third consecutive year of decline. Suicides [also] went down in April and May of last year, a different trend than in years past, Farida Ahmad, health scientist at the National Center for Health Statistics, tells Axios.

This is astonishing. And it defies expectations, with many predicting that COVID and the economic shutdowns would lead to a massive spike in suicide. And yet, that hasn’t been the case, despite the increase in every other category that would be a predictive factor for an increase in suicides, including mental illness, unemployment, and suicide.

This begs the question…why? What’s going on here? I’ve read a few articles on the subject, and they offer some different thoughts:

  • Telehealth played a big role. In many states, it became easier than ever to access mental health resources, as regulations were waved that enabled people to get access to telehealth. As a result, more people may have been able to seek mental health resources, thus saving their life.
  • There were huge, concentrated efforts to encourage people to get mental health help – maybe more so than ever before. Governor’s across the country spoke about it. People still do to this day. As a result, it seems possible that stigma – once a formidable barrier – was shattered. This may have put more people into mental health help.
  • Some noted that it seemed possible that a “heroism effect” was in place – similar to that which occurs at the start of a war or another catastrophe – where a sense of “we’re all in this together” kept more alive. If this is truly the case, then we need to be cautious, as it seems like that such an impact would fade over time.
  • The pandemic forced a massive reevaluation of the way we look at our lives, as more people found that they could live without certain things, and are thus able to live better lives. This is an interesting philosophical argument, one that may also be playing a role in the decline of workers across the economy.

It is also worth noting that a more advanced look at the data is needed: For example, did suicide decrease more in some groups? Did it particularly spike among teenagers and young adults, groups that were believed to be facing particular difficulties during this pandemic? Furthermore, what about differences among racial and economic demographics? What about people who could work at home versus those who could not?

My opinion? All of the above, and then some. I’d also offer this caution…there is no way, no way, that this is it, that we are now on a glide path towards a permanent reduction of suicide. I am absolutely concerned about the long-term impacts this will have on mental health, as well as how this may drive up suicide rates. There is so much more to this story that we absolutely do not understand, and I really hope that others have more insight than me!

Anything to add? Any thoughts about why suicide may have dropped as it did? Let us know in the comments below!

The Potential – And Frustration – of Mental Health Awareness Month

For decades, May has been “Mental Health Awareness Month,” an event formally observed by governmental actors and non-profit stakeholders alike. As a governmental official, I have seen my share of “awareness” days, weeks, and months, and taken the opportunity to deliver quite a few proclamations. Some of them get absurd. My all-time favorite was “Lake Awareness Month.” Different story.

Anyway, these events are important. They give people the chance to highlight timely and relevant societal ills and issues. They give advocates a platform to speak their mind and discuss what important things are occurring within their universe. For mental health advocates, it gives us a chance to talk about the signs of mental illness, suicide prevention, and talk about our issues in front of broader forms. At their core “awareness” events are useful tools for generating media attention and making sure that the public has an idea of what you are up to.

For issues like mental illness – issues that remain highly stigmatized or self-stigmatized – this is very, very important. These events can seem trite sometimes, but they do have meaning, as they can help steer people towards resources or make them become aware of problems from which they or a loved one suffers.

There’s a heck of a “but” here, though. It’s as simple as this: Awareness shouldn’t be confused for action.

What do I mean? Alright, I can’t tell you how many times I’ve been to an event on some important issue or other and listened to other elected officials talk about why this issue was so important. Here’s the thing: I KNOW that the elected official who is there wouldn’t do a thing to lift up the issue. We all show up at events – that’s good, and to be expected. But showing up at an event and collecting kudos for being present somewhere is a cheap way of scoring points. To quote an expression that President Biden attributes to his Dad, “Don’t tell me what you value. Show me your budget, and I’ll tell you what you value.”

This is huge. I’m tired of hearing nice words. Match it with funding, and tell me how you’d get the money to make it happen. Presentations, citations, awareness, it’s not enough. Give me the cold, hard cash to fund the programs necessary to help people.

So, what does this mean for a normal person? Well, simply. First, if someone shows up with a proclamation or a card, that’s great. It’s important. I never want to take away from the action of bringing attention to an important and relevant topic. However, that’s not enough, and don’t let any politician get away with it. Instead of saying thank you and posting for pictures, ask your elected official what they are doing on mental health. What issues are they involved with, specifically? What funding increases are they examining? Are the open for a meeting when you can talk to them more?

Oh, and let me add: This strategy and these comments don’t just apply to mental health and mental illness. They can work across the board on any number of issues.

At the end of the day, awareness is great. For some issues – particularly ones that are under-discussed, they are huge. But it’s not enough. Don’t let any politician tell you that it is.

Depression as a Roguelike

Okay, let me say right off the bat that this entry is going to be nerdy. I mean, SUPER nerdy. Video game genre level of nerdy. That being said, even if you aren’t that level of nerd, I think this entry may have something to offer you that you can connect with.

My favorite type of genre of video games, I have finally come to realize, is a type of game called “roguelikes.” Hear me out. Stop rolling your eyes. I promise this will get to depression and mental health.

So, Roguelikes. They’re games in which you have to get to the end. My favorite all-time Roguelike – maybe my favorite all-time game at this point – is one called Enter the Gungeon. I cannot understate how obsessed I am with this one.

Games like this are designed for you to die. Like, a lot. A lot, a lot, a lot. They are typically very, very difficult games. What makes them a little extra special – and extra difficult – is that they’re never the same. The games often use a randomization procedure known as “procedural generation.” In these games, levels and bad guys will change. Layouts change. And while the game will follow the same certain pattern, it’s never the same run through the dungeon.

So, what does this Sisyphean-like task have to do with depression? Well…a lot, actually. Take Enter the Gungeon. You will die a gazillion times in this game before you make it to the final boss – and then all the secret final bosses – which is a different story. But, every time you beat a level boss, you gain these extra tokens. You use those tokens to buy better weapons for your next run. Then, you’re next time, you do a little bit better. You get a little further.

Even more importantly: The more you play, the more you learn the patterns. Like, this little bastard, who my kids call the Pinky Malinky enemy:

 

He’s blurry, but deadly

Pinky Malinky up there will fire a shotgun spread at you as you walked. The first time I ever saw him, I was totally taken aback. The second time, same. By the third time, I had it, and I rolled out of the way. 

Of course, that’s not to say that the knowledge of what he does makes me immune from screwing up. Every now and then, I’ll get distracting by dealing with another one of the little guys that shoot at me, and I’ll take a hit. But I learn. I always learn.

See where I’m going with this?

It’s kind of a weird metaphor, but it does hold. My favorite type of video game genre, Roguelikes, is very, very similar to how all of us battle mental illness. Consider the similarities:

  • No two days are ever really, truly the same – but you recognize the patterns.
  • Recognizing the patterns of a Roguelike level means you can learn how to better cope with an attack.
  • Once you learn the patterns, you have a better shot at defeating your enemies.
  • The bad guys appear in different orders, at different times, and in combination with different things, but it doesn’t mean that they aren’t different.
  • Just because you know how to kill them doesn’t mean you always will. Sometimes you have a terrible day and get a Game Over at level one. Other times, you make it to the final boss without batting an eye.
  • Randomness plays an important role – but your skill often is what makes the difference.

Look, video games are an important part of my life. They’ve given me a virtually endless source of joy or entertainment, inspired the names of my kids, and taught me some exceptionally valuable life lessons about persistence and creativity. But I do really, truly believe that there are parallels between how we fight depression and how we play some types of games. I hope this helped to provide you with a valuable metaphor, and please let us know in the comments your thoughts.

Now, please listen to this kick-ass soundtrack:

Rural America and Mental Health

This is something I’d been working on in the real job, and it occurred to me that it might be an interesting topic to explore here.

So, my legislative district is urban and suburban. This comes with the usual struggles: Poverty, educational access, economic attainment, health care access, and more. To be clear, the challenges facing urban America are massive and monstrous. I deal with them every day, and that unquestionably applies to the area of mental health, where the impacts of poverty, crime, trauma, and addiction are deleritous towards the impacts of the lives of urban residents.

That being said, I don’t think we do a good enough job of flipping this topic and talking about the challenges that rural America faces when it comes to mental health. I’ve written about this topic before, but with a specific focus on suicide. I want to broaden that a bit.

First, let’s be clear: In a lot of ways, the challenges facing rural America from a mental health perspective are worse than that of their urban counterparts. This is for many reasons, including:

  • More depressed economies: In total, urban and suburban areas are growing, while rural areas are stagnating or shrinking. Economics do not necessarily predict mental health, but they can predict access to health care. Furthermore, negative changes in economic status are a predictive factor of people developing mental health issues.
  • Less access to health care: Rural America is more likely to have health care access challenges than their urban or suburban counterparts. There are fewer hospitals, and doctors/other health care professionals are less likely to go to rural areas. As a result, a rural resident may miss that they have a mental health challenge, and even if they are aware of their problems, they may not be able to find a doctor they can easily get to – particularly given the transportation problems in rural America and the lack of access to mass transit. Telehealth can help address some of these issues, but again, much of rural America doesn’t have the broadband access they need to make this work.
  • Higher rates of addiction: Rural America tends to have higher levels of addiction than their urban or suburban counterparts.
  • Higher rates of firearms ownership: Unfortunately, this pertains directly to suicide – more guns means more suicide. This is why there are more suicides per capita in rural America than elsewhere.

So, what’s the answer? Okay. Some of these are above my paygrade. I am not capable of reviving the economy of rural America. I cannot relieve their economic pressures, though I will say that I do believe that the progressive policies I support can help address these issues.

That being said, yes. Progressive policies, in my opinion, can help. Dealing with health care access, a lack of broadband internet, rates of addiction…guys, this requires investing money. Increased reimbursement rates for physicians, psychiatrists, and psychologists to encourage more people to enroll in mental health specialties. Grants for construction and increased funding for operations for hospitals. Increased investment to open drug treatment centers. A minimum wage that isn’t a catastrophe. Targeted tax incentives to alleviate the pain faced by rural farmers. It’s funny because typically, rural Americans vote for more conservative politicians and policy outcomes. I would argue they are voting against their own interests here.

That being said, an honest answer acknowledges that this is more than just politics or policy. Rural America faces unique challenges that cannot be solved with the drop of a hat or the wave of the magic money wand, and these challenges require long-term investment, comprehensive solutions, and answers more than whatever I have thought of.

Still, as a long-time elected official for a depressed urban area, I have nothing but sympathy for my rural friends. They deserve real answers and real investment. I hope we can figure out comprehensive solutions to their problems and pain.

The Mental Health Benefits of Doggos and Other Animal Friends

According to my Facebook memories, one year ago today, I wrote, “The only true winners of the pandemic are the pets.”

The picture above is the pet, Lexi. We got her in August 2019, and she has been our bestie ever since. She is sweet, lovable, patient, insane, and a wonderful addition to our family. We got her about six months after we lost Molly and a few weeks after we tried – and failed – to foster Mack.

I said it to my wife a thousand times, and it’s true: Lexi made the pandemic so, so much easier. She was a constant companion, a source of amusement, and basically just seemed…pretty glad to have us around. She seemed to just make us happier.

I just wanted to point this out – that’s a very, very real feeling. Doggos help, big time. From a mental health perspective, they:

  • Reduce depression
  • Ease the symptoms of a variety of mental illnesses, including anxiety, depression, and PTSD
  • Lower stress hormones
  • Reduce anxiety felt in children
  • Fill us with love and affection

There are a variety of physical benefits as well, including an increase in exercise, lower cholesterol, and improved heart disease. 

Oh…cats. Fine. I’m a dog person – and, unless I’m mistaken, I’ve found more articles about dogs than cats. However, cats do have real benefits on our physical and mental health, with some studies indicating that they lower blood pressure.

Actually, let me add one more thing. For years, Auron has wanted a fish. I mean, years. We told him – years ago – we’d do it when he was ten. To my disbelief, he actually remembered! Well, Auron turned ten the other day, and his Pappy got him a fish. We were all actually really clear with him: This is yours, buddy. You will be responsible for cleaning and feeding it – yes, we are supervising, I don’t want the damn thing to die.

To be clear, don’t get a dog to cure your depression. That’s not fair to the dog. They are living, breathing things. They are real, intense, and expensive responsibilities. But, if you have the time and the money, they are so, so worth it. If you are on the fence, keep that in mind. They are utter joys. And they can make us feel good.

Go Outside: It’s Good for Your Depression – and a Whole Lot More

Let me start by acknowledging that I’m really lucky that I can actually type this up. I have a nice house with a big backyard. Not everyone is able to do this. However, if you can, if it’s nice enough, you have the means to do so, and you have the space to do so – please go outside.

When I was younger, I went outside more often. That slowed as I got older, and I couldn’t even really tell you why. I was never a backyard kind of guy. Then we spent ten years in a home with a relatively small backyard (albeit a nice porch) and I didn’t see much of a point of going out. That changed as I did more research. One book in particular sticks with me – I’ve written about it before – The Depression Cure by Dr. Stephen Ilardi. The book argues that depression came from the way we have crafted civilization and that more time outdoors is necessary to address depression. I had other issues with the book, but on this point, I think is absolutely right.

The basic crux is that going outside helps make you feel more relaxed, more at peace, and more connected to others – even if there is no one around. And it’s backed up by some research:

  • One analysis of ten studies found that self-esteem and mood could be improved for people who spent more time outside.
  • People who walked in nature showed lower activity in brain centers associated with rumination, as opposed to those who walked in an urban center.
  • Being close to nature or “greenspace” can reduce stress, symptoms of anxiety, and provide children with ADD or ADHD additional cognitive benefits.
  • Nature is also associated with lower stress levels and higher levels of relaxation.

Alright, fine, going outside is good for your mental health. That probably isn’t really much of a surprise to you. It also helps explain why I’ve spent so much dam money on my backyard of late. But, let’s be clear, there are implications here that go a bit beyond the need to get some fresh air. Let’s go back to my disclaimer at the front of this article: What about people who don’t have a backyard? People who live in a heavily urbanized area and don’t have nearby public parks or nice amenities? People who are physically disabled and thus unable to easily access the benefits of nature?

Well…I mean, let’s be honest, they’re not going to get the benefit that the rest of us will. And that’s deeply unfair.

Of course, the benefits of nature, parks, greenways, and waterways are about more than improving your mood. Studies also show that access to nature can improve your physical health and provide a sense of connection with others. It can also improve your memory, your concentration, and help you lose weight. It’s pretty clear that being able to get outside in a high-quality space is about more than just improving your mood. It can do a lot more, and maybe, if Dr. Ilardi’s theory is to be believed, help people reconnect with something deeply biological within them.

So, if you can, go outside. Also – if you can – let’s all do a better job of advocating for high-quality public spaces that can be accessible to all of us, regardless of our income levels, where we live, or our levels of physical functioning.

The Rise of Telehealth

Telehealth wasn’t new to COVID-19. The concept has been around for decades and applies differently to different areas of medicine. That being said, one of its most positive potential uses has been in the area of mental health, and in that regard, COVID-19 may have pushed us towards telehealth in a big way.

First, check out this USA Today article on the subject. This line stuck with me:

Prior to the pandemic, Blue Cross Blue Shield of Massachusetts received about 200 telehealth claims per day. That number reached up to 40,0000 claims per day from April to May 2020, and the insurer is still receiving about 30,000 claims per day almost a year later, according to spokesperson Amy McHugh.

The article also noted that ” mental health appointments made up about 53% of the 7.5 million telehealth claims processed by Blue Cross Blue Shield of Massachusetts since March 2020.”

This isn’t a surprise, and many of us have had experiences with it. I know I had numerous virtual appointments via telehealth over this pandemic, and I found it every bit as effective as an in-person visit. Maybe even more so – the flexibility that came with it was highly beneficial. I remember having a therapy appointment from my office in Harrisburg!

Of course, it’s not for everyone, but there is unquestionably good news in the area of telehealth. According to a 2020 article from the American Psychological Association, telehealth seems to be working so far. There are even some questions as to whether or not telehealth may be more effective for some groups that are typically less willing to visit a psychiatrists office – like men – as it allows them to get therapy without having to leave their house, thus reducing potential barriers and making it easier for them to overcome self-imposed stigma.

The USA Today article also noted that telehealth can make a therapist more efficient. Said one therapist, “I probably spend somewhere between 2 to 5 minutes per patient moving from one room to another or pausing to document or checking something on their file or handing something off. There are built-in inefficiencies that isn’t time spending with the person… but some of those inefficiencies are taken care of by the fact that everything is electronic.”

Obviously, COVID pushed us more this way as part of all of our efforts to socially distance. However, major challenges remain in terms of full utilization and effectiveness of telehealth services. First, telehealth is predicated on the idea that someone has the broadband infrastructure and necessary equipment. As this pandemic has shown, that is NOT the case for everyone, particularly among rural Americans or the urban poor. Lacking such equipment means that someone will not be able to get the help they need.

Furthermore, there are insurance barriers. Not all insurance companies cover telehealth, and while states of emergency have knocked down many of these barriers, they haven’t destroyed all. As such, insurance regulations need to be updated in many states. However, this presents a problem in and of itself. For example, in Pennsylvania, the issue has been tripped up due to attempts to limit telehealth services and prevent abortion services from being prescribed or conducted via telehealth. Don’t ask.

The point is this: Telehealth is great, but we’ve got a long way to go.

Let me conclude with this: Did you have a telehealth experience with COVID-19? What was it like? Did you find it to be as effective as an in-person visit? We’d love to hear from you – give us your comments below!

Coming Back To Normal

Ahh, the blog entry I’ve been wanting to write for so, so long.

Slowly but surely…it seems like life may, just may, be returning to normal. We’ve got a long way to go, of course, but there is light at the end of the tunnel that is getting brighter by the moment.

A quick look at the facts. As I type this entry on March 14, the United States is making real progress. Excluding an odd data dump, March 13 set the new one-day record for vaccinations, with 2.9 million people vaccinated. 100 million doses have been administered. 13% of all adults are now fully vaccinated, and about 20% of the population has had at least one dose. It’s not herd immunity, but it’s real progress, and the rate of progress is accelerating.

So, what does all this mean? The increasing rates of vaccines and the relatively steady rates of cases implies that we are starting to get to the point that we can resume normal life. Restrictions on businesses and crowds are starting to be loosened, although some states are obviously taking that way too far. Schools are starting to reopen fully or in more hybrid modes. Of course, thanks to new CDC guidelines, families are getting together again, hanging out with fully vaccinated grandparents for the first time.

On March 9, I had lunch with my Mom. Also, this happened:

My parents and in-laws – both fully vaccinated and post two-weeks – have been over, as per the CDC guidelines. There have been snuggles with the grandkids. A year’s worth of snuggles.

Of course, this is all wonderful news. It is desperately needed and wanted. Life is starting to resume. But, that asks a few questions: What does THAT mean from a mental health perspective? Specifically, what are the dangers of this new moment as life gets back to normal?

A few thoughts. First of all, readjustment will be hard for all of us. Events will resume, as will seeing people. Handshakes may come back…maybe. That’s going to be a challenge. I mean, think about it. For most of us, we’ve avoided crowds or crowded buildings. How will we adjust to being near people again?

Another example: Take events. How are any of us going to get used to being around people again? Will it cause major spikes in anxiety?

What about people who have been able to work from home and be near their kids and pets all the time? How will those individuals adjust to being away from their families again?

For people who are in psychologically vulnerable states to begin with, the readjustment may cause real issues. Keep in mind that being “forced” to stay home with loved ones hasn’t been a big problem for many! As such, it begs the question – how will individuals like this react as they resume “normal” activities? And what about people who suffer from anxiety disorders and OCD? What challenges will they face at this moment? After a year of staying home, how will they adjust to being put into an area where there are germs everywhere – even if they have been fully vaccinated?

It goes without saying that these are questions that we should all be grateful we are able to ask. I want us to get back to normal as soon as possible and to resume the lives that we left behind about a year ago. However, this moment is not without its dangers or its struggles. These are things we should monitor in order to ensure that our transition back to “normal” life goes as smoothly as possible.

Lessons That Go Beyond – Applying Tinnitus Lessons to the Rest of My Life

So, as I said some months ago, I managed to jump in a pool funny and develop Tinnitus in my left ear. Yes, it’s every bit as fun as it sounds. For those of who you are (blessed enough to be) unfamiliar, Tinnitus is a ringing in your ear that is non-stop. And it suuuuuuuuucks, let me just tell you. That was about seven months ago now, and there’s never really been a time that it has gone away. So, with some painful brief exceptions, I haven’t really heard silence since early August. It has certainly gotten better, and there are some days where it is better than others, but yeah…it sucks. And no, there is no cure, although some are being researched and show promise. I’m cautiously optimistic that there may be real, physical remedies in the next few years.

Anyway, no, I am not writing this to whine or get sympathy. Actually, I’m writing to share one of the things I learned from it, in the hope that my experiences can positively affect you.

To be clear, the first few weeks I had it was exceptionally difficult. Anxiety and depression are fairly common for Tinnitus sufferers, and they tend to get worse if you already suffer from these disorders…like me. And tinnitus can be even more emotionally painful if you have something called hyperacusis, which is defined as an extreme sensitivity to sound. Yep. Me again.

The first few weeks I had the tinnitus were particularly bad, and I wound up seeing my therapist for it. Interestingly, although there are no physical cures for tinnitus, there are a variety of behavioral techniques and ways in which counseling can help you deal with tinnitus. My therapist…God bless him…was exceptionally helpful in allowing me to identify these techniques.

One such way, and what I wanted to write about today, was something that I alluded to several months ago: Using my new chronic condition for personal growth. I have tried to parallel my new experience with tinnitus to my experiences with depression and anxiety. While both have obviously been hellish experiences, I wouldn’t trade them. They made me stronger, more empathetic and gave me a sense of purpose as a legislator and writer that I never would have had otherwise. It is so strange to say that depression and anxiety made my life so much more joyful and meaningful.

One of the most useful techniques in terms of tinnitus management basically boils down to this: Acknowledge it and move it. There are periods I can forget about the tinnitus – usually when I am wrapped up in work or something fun. I always laugh about it, but the longest I ever went without hearing the ringing in my ear was the day I ran for House leadership – I didn’t hear it for almost the entire day, as I was so intent on making the phone calls and attending the meetings that I needed to attend to win.

Anyway, those moments and days are few and far between, and there are plenty of moments where I hear the tinnitus and get annoyed distracted, sad, or angry. At those moments, one of the things my therapist taught me was to more or less say, “Oh, yep, you’re there. Hello. Nice to see you. Anyway….” and to move on. That requires a letting go and acceptance that I am just terrible at. But, what I will say is that I am learning and getting better. In turn, my tinnitus is getting better. You acknowledge that it’s there but try to remove the emotional connection with it. Studies have shown that the stress and distress you feel with tinnitus aren’t tied to perceived loudness. This means that your level of stress and how you deal with the tinnitus is much more impactful than its actual frequency or volume!

This brings me to a fascinating experience I had last week. As I said above, I have tried to see my depression and anxiety experiences to make myself a better person. When the tinnitus first started, I pledged to try to do the same with the disorder. Doing so, in my mind, would make the tinnitus worth it. And that brings me to this experience.

So, I see something stupid on Facebook. Someone had said something insulting or ignorant, and I’m annoyed by it. And I just have this very quick, almost automatic thought: “Whatever, I know it’s bothering me, but I’ll just acknowledge it and move on…oh–”

It was my Tinnitus process hitting something more real.

Look, this thing sucks. And I won’t pretend otherwise. BUT, that doesn’t mean that good can’t come from it. It doesn’t mean that you cannot experience something good from something just absolutely terrible. And I hope I will continue to take the lessons I’ve learned from Tinnitus and apply them to the rest of my life.

More importantly: I hope you can keep this motto as well. I hope you can try to find the good in the bad and apply lessons you’ve learned from negative experiences into positive ones. Negative experiences, terrible tragedies, horrible events – I am not stupid enough to say that they are “worth it” or won’t cause you endless hours of pain or torment. But what I will say is that one way of dealing with these experiences is to try to take the lessons learned in order to make them more “worth it.” I have found this to be an excellent coping mechanism, one that has helped me take a real challenge and turn it into something positive. I hope this is something you can do, too.

Why is it so hard to find a therapist?

If I hear about one issue related to mental health over and over, it’s this: Why can’t I find someone to see me? Why is it so hard to find a therapist? Why can’t I find a bed to help me with my loved one who needs hospitalization? It is, unquestionably, the most frustrating issue in the mental health world – one that I would argue is more frustrating and problematic than general issues like access, affordability, parity, and stigma. Heck, we could solve all of these issues, but if we can’t get people into a therapist, it doesn’t matter.

The reason, roughly, comes down to this: A shortage of practitioners.

There is a well-documented shortage of mental health practitioners. According to available information, the shortage is growing across all fronts, including marriage and family therapists, psychiatrists, psychologists, and more. This shortage is particularly acute in some areas, like poorer states, or more rural states. It also gets worse as you start getting into specific areas of mental health, like geriatric or pediatrics psychology. In my home – the Lehigh Valley, Pennsylvania – we’re actually comparatively in good shape. This may come as a surprise to many people in our area!

So, why is there such a shortage? As you can imagine, there are many reasons. The biggest one is reimbursement rates. Simply put, psychiatrists and psychologists are not paid as much by insurance companies or Medicare/Medicaid as other doctors, particularly specialists. This, in turn, leads docs to go into more lucrative fields. That’s not it, of course. In fact, one of my legislative colleagues, Rep. Jeanne McNeill, was able to get a resolution passed that studied the mental health care practitioner shortage in Pennsylvania. That study identified numerous reasons, including regulatory barriers, burnout, parity issues, and information sharing.

What can we do about it? An in-depth analysis is well beyond my ability to address in a blog entry that I usually try not to break 500 words with, but in a nutshell, I think it comes down to investment. Everything above can be addressed with money. Not eliminated, of course. But absolutely addressed.

And, just like that, we’re back at my favorite topic. Everyone says they care about mental health. Great, neat. Can we do something about it? Can we pretend that it actually matters and invest in things like our workforce? In telehealth laws that will ensure that everyone has good access to mental health care, and broadband services to ensure that rural Americans can actually see a doctor no matter where they live? Can we enforce parity laws and ensure that larger insurance companies are meeting their needs when it comes to mental health coverage? Can we get the federal government to expand what they pay for in terms of mental health?

Gah. I’m on my soapbox again. But what I’m saying is accurate! Until the day comes that we actually treat mental health with the seriousness that it deserves, we’re gonna have practitioner shortages. This will limit the number of people that can get the care they deserve.