By ARPAN WAGHRAY, MD and BENJAMIN F. MILLER, PsyD
Benjamin F. Miller
Arpan Waghray
If someone we love has a physical ailment, we can list a variety of places for them to seek care: a clinician’s office, a pharmacy, an urgent care clinic, a school health clinic, an emergency department — the list goes on.
And, in every case, we would feel confident the clinicians in those places would know how to handle the case — or at least know where to send the patient if they need more intensive or specialized care.
But, sadly, the same isn’t true for a loved one with a mental health or substance misuse need, even thought mental health problems are more prevalent than many physical conditions.
As deaths of despair from drug or alcohol misuse or suicide continue to rise, we need a comprehensive, coordinated “no wrong door” approach that fully integrates mental health into the health care system and beyond. We need to transform our clinical practice, creating more options for care and putting mental health and substance use patients’ best interests first. Policy and payment reform must happen to make this new vision of care possible.

Consider that there are an estimated 44 million U.S. adults with mental illness, and more than half  — 24 million — did not get treatment in the past year. Among the 1 in 5 adults who did seek treatment, many did not receive the optimal, evidence-based care they needed. Even worse, 6 in 10 young people with severe depression received no treatment, a risk factor for depression in adulthood. Imagine if half the people with broken arms just had to figure out a way to manage it on their own.
There are many reasons people don’t get adequate mental health care or any at all, from stigma to lack of health insurance coverage. But

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