john Oliver delved into the sorry state of mental health care in the US, which has only been hit harder by the rise in mental health issues during the pandemic. In 2020, four in 10 Americans reported symptoms of anxiety or a depressive disorder, up from one in 10 in 2019. “It may help explain why during that month last year, everyone on the internet suddenly started singing shanties marinas,” the Last Week Tonight host said on Sunday night. “It was clearly a collective cry for help.”
But despite widespread awareness of the problem, people seeking help are finding a system that is “simply not set up to provide it.”
On the one hand, there is an overwhelming demand for a shortage of mental health professionals. According to the American Psychological Association, in 2021, 65% of psychologists reported that they did not have capacity for new patients. A Senate report found that more than half of Americans who need mental health care do not receive it, with higher rates for minorities. Oliver singled out a black man in an NBC News report who said he couldn’t find a black male therapist “for my life.”
“Wow, ‘I couldn’t find a black man for my life’ is not something you expect to hear about finding a therapist,” Oliver said. “It’s something you’re most looking forward to hearing from the crowd on January 6 or all 10 seasons of Friends.”
“In general, whether it’s small towns or big cities, we don’t have enough mental health professionals,” he said, a gap that has proven attractive to Silicon Valley. Tech companies like Woebot, Talkspace and Chatbot “claim to connect you with therapists and in some cases medication,” Oliver said. “They are basically Uber, but for your brain.
“And look, there is nothing inherently wrong with teletherapy,” he continued. “In theory, it can help fill some of the very real gaps in access,” but “the reality of these services has often been deeply disappointing.” The Cerebral company, for example, became the subject of a federal investigation into whether over-prescribed controlled substances like Adderall.
“It’s clear that mental health apps aren’t going to save us here, because they don’t address the main underlying problem,” Oliver said, since “they can’t suddenly hire more doctors if there aren’t enough of them. And that shortage speaks to a mental health system that is so dysfunctional that it seems almost designed to prevent people from accessing it or providers from entering the field.”
This is despite so-called “parity” laws at the state and federal levels, which require insurance companies to reimburse mental health care at the same rate as other health services. However, Oliver noted, insurance companies have found ways to deny coverage, such as through “ghost networks,” which are insurance provider lists filled with doctors who are not accepting new patients or are no longer in the network. of coverage.
Insurance companies also dropped coverage in the middle of treatment; Oliver pointed to the case of an Ohio family stranded for $88,000 of their own money after hospital care for their suicidal teen was deemed “medically unnecessary” by insurance.
“If you’re wondering how insurers can get away with that kind of thinking,” Oliver explained, “it’s partly because the government, up to this point, has done surprisingly little when it comes to enforcing parity laws.” Federal and state agencies rarely sanction insurance plans: The Labor Department closed just 74 parity investigations in fiscal year 2021 and found violations in just 12; State-level enforcement has imposed fines only 13 times since 2017, “which is absolutely pathetic,” Oliver said. Public insurers like Medicare and Medicaid also reimburse community health providers, whose own funds have deteriorated, at “woefully insufficient” levels.
“Basically, from top to bottom, we pay mental health professionals significantly less,” Oliver said, “many of whom do difficult, high-exhaustion work.”
Overworked, underpaid, struggling to make ends meet unless they practice in a high-density, high-wealth area — “therapists are in a no-win situation here,” Oliver added, referring to a clip from news in which anonymous mental health providers say they’re being run into the ground for low reimbursements. “For what it’s worth, it’s not a good sign that insurance companies are now so powerful that mental health providers feel like they have to go out on the news like they’re in witness protection after seeing someone get beat up.”
The costs of not addressing the crisis are high: Mental health issues cause homelessness and force people into contact with the criminal justice system. “It is often said that correctional facilities have become the largest providers of mental health services in our country,” Oliver said. “We basically went from storing mentally ill people in buildings that looked like prisons,” like sanatoriums in the early 20th century, “to storing them in actual prisons. It’s very much the new look, the same great flavor of America’s failures.”
How to fix it? “Clearly this is an absurd way to operate a health care system and for the umpteenth time I would say single payer health care is the way to go,” Oliver said. Instead of that political failure, he’s strengthening and enforcing mental health parity laws, like in California, which in 2020 passed a measure requiring insurance companies to base “medical necessity” decisions on current standards, not on the criteria that they themselves impose.
“In the past, a lot of the problem here was people not asking for help. And thankfully, that’s less of an issue now,” Oliver concluded. “But now, when people seek help, we are simply not in a position to give it to them. If we want to be a society that truly respects and values mental health, we have to respect and value mental health care, and that means supporting the people who provide it.”
