BY JOYCE CLARK HICKS When I first heard about Ebony Wilkerson, the pregnant mother of three who tried to drown her children by driving her minivan into the Florida surf, I immediately labeled her as mentally ill. My second assumption was that our mental health care system had yet again failed to get a woman the help she so desperately needed. In North Carolina, 335,000 adults live with serious mental illness, and yet our state serves only 34 percent of them.
Later reports on the Wilkerson story confirmed my suspicions. On the day of the incident, Wilkerson told her sister she heard demons. Police, who stopped Wilkerson just hours before the incident, let her go even though they noted signs of “mental illness.”
For all this talk of expanded access to comprehensive health coverage under the Affordable Care Act, will our health care system ever help the mentally ill before they hit a crisis state? Or will we continue to fail women and children like the Wilkerson family? In a country where more than 18 percent of American adults experienced some form of mental illness in 2012, and more than 60 percent of adults with mental illness received no mental health services, the need for an intervention is immediate and great.
The good news is that the Affordable Care Act requires insurers to cover mental health and substance abuse services as one of ten “essential health benefits.” Specific benefits vary from state to state and depend on the plan you choose. People who haven’t been able to get insurance in the past because of diagnoses such as depression, anxiety, and bipolar disorders can now get coverage.
The bad news is that North Carolina did not expand Medicaid for our state’s poorest residents. If you live at or near the poverty level, you may not reap the benefits of expanded mental health coverage. The other bad news is that our country appears woefully unprepared to meet the demand for mental health services. The number of licensed psychiatrists has been decreasing while the general population’s need for psychiatrists has been growing. Fifty-seven percent of psychiatrists are age 55 and older and nearing the age of retirement.
A study by Dr. Tara Bishop, an assistant professor of public health and medicine at Weill Cornell Medical College, found that only 55 percent of psychiatrists accept insurance or Medicare and only 43 percent accept Medicaid. The shortage of providers enables psychiatrists to fill their appointment calendars with cash-only customers. Meanwhile, increased demand means that the waiting time to see a mental health specialist can take up to weeks or months. We see time and time again that the mentally ill cannot afford to wait.
The Affordable Care Act is a critical and welcome step forward on a path rife with challenges. But with so many tragedies at the hands of the mentally ill, we need giant steps forward—and we need them now. As the Wilkerson children can attest, we’ve waited long enough.