The SSRI- a symbol of a failing mental health care system Part 1

In the grand scheme of medicine, psychiatry is incredibly young. To understand why the sudden rejection of current psychiatric medications is dangerous and worrisome, you need to understand the history of how mental health medicine has been viewed going back to the 1950’s.

JFK’s administration brought to light the abuse and neglect going on in large government-funded psychiatric institutions and sought to deinstitutionalize-to bring people back out into their communities, managing their care in the outpatient setting with therapy, crisis management, social support, case management, rehabilitation programs, etc. With the death of President Kennedy, the priorities of the federal government shifted, and the states inherited the responsibility but lacked resources. The US continued to siphon mental health funding into 1970s and 1980s, resulting in closed mental health hospitals and now have a smaller system built on a corporate business model with few community health options.

Since the second Trump inauguration, the largest mental health funding changes have involved behavioral health grants, workforce programs, and restructuring within federal agencies, cutting somewhere between $1,000,000,000-$3,000,000,000 (had to type all those zeros to make drive home the point) in mental health and addiction-related funding reductions or disruptions (so far). Much larger cuts have been proposed, especially to research, an area of health and safety we have already seen get the slip early on in this administration. We have cut off much of the funding to community mental health programs, workforce development, prevention efforts, and grant-funded services.

Main issues we are seeing today with this:

• Insurance reimbursement increasingly awarding shorter visit, normalized 15 min appointment times.

• Medication being one of the only intervention the insurance consistently reimburses quickly, efficiently, and at-scale.

• Therapy becoming financially inaccessible for many.

• Primary care providers managing much of the mental health of the country.

Ultimately this has led to a care model that looks as though your psychiatry providers don’t care. However, the truth is that we are practicing inside a system that rewards volume of comprehensiveness. The goal is to keep patients mentally well, so they don’t die by suicide, harm themselves or others, or endure a hospital stay or rehab stay that puts them into financial peril.

We are (quite understandably) very frustrated with this. Frustration creates a swing of the pendulum. While millions have genuinely regained function, returned to work, reconnected with themselves or loved ones, or simply survived due to taking an SSRI, we have still managed to go from “medication can help” to “medication is the problem.” Shaming our fellow humans for getting help with medication is not that answer, it is to rebuild our current mental healthcare system.

Comprehensive mental health care has becoming incredibly difficult to access. We deserve a healthcare system offering something better than rush appointment and survival-level support.

Well, this has me fired up so I’m going to take a breath and work on the next part of this. Stay tuned for part II.

Katy Goggins, PMHNP