Casting a Wider Net

This post was written by Dr. Matthew Wintersteen. Dr. Wintersteen’s work is in suicide prevention, with a focus on youths and adolescents. He is a board certified licensed psychologist, and serves as the Director of Research in the Division of Child & Adolescent Psychiatry at Thomas Jefferson University.

For 80 years San Francisco has celebrated the beauty of its greatest landmark, the Golden Gate Bridge. But sadly, it also wrestles with the dilemma that every two weeks someone chooses to end their life by jumping off it into the San Francisco Bay. In an attempt to curtail this disturbing trend, the city will begin installing a net that extends 20 feet out along both sides of the 1.7 mile long span.

If similar suicide barriers are any precedent, the netting project beneath the Golden Gate Bridge should achieve its goal of reducing unnecessary deaths. As noted in “Jumpers,” a 2003 New Yorker article – which inspired the documentary film “The Bridge” – the Empire State Building, the Duomo, St. Peter’s Basilica and Sydney Harbor Bridge were all suicide destinations before barriers were erected on them.

While physical barriers at bridges may keep people from jumping or save them if they do, the solution fails to address the bigger issue: that people with mental illness are not getting access to the help they need, or they simply cannot afford it. Effective treatments and interventions exist that can reduce suicidal thoughts and behaviors. But given the current political climate, the state of mental health care in America is in dire need of its own safety net.

Republicans want to repeal the 2010 Affordable Care Act (ACA),the 2010 law that provides medical coverage to an estimated 20 million Americans and specifically included mental health and substance abuse treatment as one of 10 “essential benefits” that all private insurers and Medicaid have to cover.

This is of vital importance to the 43.6 million American adults living with a psychiatric illness and the 16.3 million who have an alcohol use disorder. Until this law was passed, people with mental illness and substance abuse problems were subject to annual or lifetime limits on coverage, higher deductibles or no coverage at all.

The ACA put an end to that, casting a wider net by mandating that psychiatric disorders be treated equally with non-psychiatric medical illnesses such as cancer and heart disease. It also prohibits the exclusion of people with pre-existing illness from medical coverage. Three-quarters of all serious mental disorders in adults – including major depression, schizophrenia and anxiety disorders – are present by age 25. So mental disorders are largely chronic illnesses that, while very treatable, are still characterized by relapses and recurrences.

Could the cost of mental health services be more affordable? Based on prohibitive deductibles specified in many plans, yes. But the fact remains that mental health services are more available under the ACA.

The stigma surrounding mental illness continues to be a major barrier to getting good treatment. No legislative action can put an end to that, nor can it solve the shortage of mental health specialists or the limited access to psychiatric treatment. But if the Republicans are successful in their plan to repeal the law, it will strip millions of Americans with mental illness of a lifeline vital to their survival.

While a suicide barrier beneath the Golden Gate Bridge may serve as a deterrent, it is but one approach and it fails to draw attention to a serious issue that has never been fully addressed in our country. Improved AND affordable access to mental health care is the real safety net we need.

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