If ACA is repealed, it will be even harder to prioritize mental health care

When it comes to investing in our health, not all issues are treated equally. This idea seems all the more relevant as we await the fate of the Affordable Care Act, leaving many concerned about covering their own health care costs.

I started thinking about how this will affect mental health care after recently grabbing coffee with a close friend, and fellow social worker, who was commenting on the high cost of her brother’s therapy.

He recently moved back home because of possible symptoms of bipolar disorder. He also struggles with gambling, and the specialized therapist he sees twice a week costs the family around $1,200 per month, which is no small price.

Plenty of people would not be able to afford such an expense, but when treating medical issues, most want the best or most specialized care available. People frequently pay exorbitant costs for clinical trials, surgical procedures, non-FDA approved drugs, and innovative treatments without question. It seems that if it will maintain health and stave off mortality then it’s worth the expense.

That ethos changes, though, in regard to mental health. In 2012, Dylan Smith of Stony Brook University Medical School published a study, “Was It Worth It? Public Willingness to Pay to Avoid Mental Illnesses Compared with General Medical Illnesses.” Its findings suggest that, despite acknowledging the severity of mental illness, respondents were willing to pay 40 percent less to avoid a mental illness compared to what they would pay to avoid a medical illness.

It’s hard to say why this disparity exists, and the investigator called for further research into understanding our values towards health care spending. One possibility is that we view mental health and medical care as separate. I am feeding into this distinction by using the label mental health, but isn’t it all health, regardless of whether it’s mental, physical, emotional, sexual, etc.?

Another possibility, the one I suspect may be to blame, is that we only tend to invest in our health when absolutely necessary. The American health care system is heavily treatment focused rather than prevention focused. Therapy, however, is one form of health care that is both a treatment and preventative. It not only safeguards against mental health issues worsening, but it also leads to improved outcomes — at work, in relationships, with family, and self-development, to name a few.

I frequently have conversations with clients about why it is still important for them to come in when things are going well. If a client is in good shape, that means what we’re doing is working. Consistent therapy creates the bandwidth to make sense of unaddressed challenges or painful memories, which need to processed in a stable state — the optimal way to develop new neuronal pathways and safely store distressing memories away in the limbic system, the brain’s home for long-term memory.

So what if therapy was seen as a way to keep us healthy and not just the way to keep things from getting worse? People spend on gym memberships, yoga classes, cleanses, diets, and more to stay healthy; therapy seems just as important to include in that mix.

I don’t know if the priority on mental health is there yet, and that seems even less likely to happen anytime soon if the ACA were to be repealed. If the 20 million people who stand to become uninsured are left to cover their medical expenses out of pocket, I worry that will diminish the number of people willing to spend on mental health care. When people become burdened with paying for treatment themselves, they begin to question what the cost is worth. This can even occur when help is needed the most, like in the case of my friend and her brother.

When people have to pay for things themselves, it is a lot easier to be burdened by the cost, like in the case of my friend’s family. If they’re questioning treatment costs for her brother when he’s at the point where he needs the most help and the best care possible; it does make me wonder — when is it worth it for people?

What’s interesting, though, is that mental health expenditures are our country’s most expensive health care costs. According to a recent report, in 2013 we spent $201 billion on mental health disorders such as depression and anxiety. The second costliest, heart conditions, cost us $147 billion. And by we, I mean taxpayers, because those were the reported figures from the U.S. Centers for Medicare and Medicaid.

I can’t help but think how different mental health care costs would be if the upfront investment seemed worth it. The consequences of decreased mental health care utilization, at a time when people are more depressed, anxious, addicted, and traumatized than ever, are not good. I would hate to see things get even worse.

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Peter Zook, is a licensed social worker in Philadelphia who practices psychotherapy at a group practice and privately.