The Wall Street Journal (9/25, A4, Beck, Subscription Publication) reports on a movement integrating mental healthcare into primary care practices. This movement is occurring as the US healthcare professionals anticipate seeing many more patients under the Affordable Care Act and its resulting mental health parity. At the same time, providing patients with psychiatric care in the primary care setting would be one way of addressing a US-wide shortage of psychiatrists. Finally, many physical and psychiatric conditions are linked, such as depression and anxiety in patients with heart disease or diabetes, and it makes sense to treat both conditions together. According to the Journal, the American Psychiatric Association has endorsed the integrated care concept.

Related Links:

— “Getting Mental-Health Care at the Doctor’s Office, “Melinda Beck, The Wall Street Journal, September 24, 2013.

In his column in the Washington Post (9/25), Courtland Milloy observes that misdiagnosis of “mental illness among black men has long been an acute problem – with consequences that extend beyond the Navy Yard killings to the daily gun violence throughout urban America.” Milloy quotes William Lawson, who chairs the psychiatry department at the Howard University College of Medicine. Lawson said that not only do African American males have less access to mental health treatment, but they are also “much more likely to be viewed as having a behavioral problem rather than a mental disorder.” Milloy concludes, “There is such a stigma around mental illness that black males themselves would rather be seen as ‘bad instead of mad,’ as Lawson puts it.” The end result is that more black males may end up incarcerated instead of getting needed treatment.

Related Links:

— “Navy Yard shooting underscores how mental illness can be misdiagnosed among black men, “Courtland Milloy, The Washington Post, September 24, 2013.

NBC Nightly News reported, “The mass shooting at the Washington Navy Yard is drawing new attention to the role of” the mental “health system in trying to prevent such violence.” Jeffrey Lieberman, MD, president of the American Psychiatric Association, said of Navy Yard shooter Aaron Alexis, “If mental healthcare was provided in the routine systematic way that general medical care was, ideally we would have expected that he would have been identified, diagnosed and offered treatment much earlier.” Chief medical editor Nancy Snyderman, MD, said, “While most people with mental illness never turn to violence, mental health advocates say that half or more of those responsible for mass shootings in recent years have suffered from a serious mental illness.”

The Rutland (VT) Herald (9/22, Freedman) quoted Dr. Lieberman, who said, “Historically, the US mental health care system is limited and badly fragmented.” He added, “As result of people lacking access to mental health care, not knowing what to do if loved ones are affected, not having insurance coverage for it, many go untreated.” According to Lieberman, “predicting which mental patient will be violent is less important that expanding treatment so that those with violent tendencies who fly under the radar get the help they need.”

Related Links:

— “Navy Yard tragedy spurs debate on mental health, “Dan Freedman, The Rutland Herald , September 22, 2013.

The Seattle Times (9/22) says in an editorial that a combination of Medicaid expansion and mental health parity in the ACA “has the potential to be revolutionary. For the first time, destitute childless adults, typically not eligible for Medicaid, will become eligible. Seattle’s Downtown Emergency Services Center alone has 27 staff ready to sign up homeless clients for health-care insurance.” It adds, “Imagine the savings – for businesses, for the criminal-justice system, for human potential – of true preventive mental-health care.”

Related Links:

— “Editorial: Affordable Care Act patches some holes in mental-health system, The Seattle Times, September 21, 2013.

The Louisville (KY) Courier-Journal (9/23, Kenning, Ungar) reports that across the US, “access to insurance and limits on services, therapy visits and hospital stays have left those with mental illness feeling treated like second-class citizens in a health system built to handle physical ailments, according to patients, providers and advocates.” Now, however, under the Affordable Care Act, health “insurers will soon be required to give mental illness coverage equal to that for physical ailments.” Beginning in 2014, “the ACA calls for one of the largest expansions of mental health and substance abuse coverage in a generation, requiring that all new small-group and individual market plans offer mental health services and cover them at a par with medical benefits.”

Related Links:

— “Obamacare pushes for parity in mental health coverage, “Chris Kenning, The Louisville Courier-Journal, September 22, 2013.