How Policy Impacts Mental Health and Patient–Provider Relationships

October 04, 2022 - According to the National Institute of Mental Health, approximately 20% of adults in the United States struggle with a mental health disorder. The prevalence of mental health disorders among women is nearly 10% greater than men. That said, understanding the biggest challenges in women’s mental health, barriers to accessing services, and how policy impacts patient–provider relationships is essential.

LifeScienceIntelligence sat down with Ashley Junghans-Rutelonis, PhD, clinical psychologist and women’s mental health expert, to discuss women’s mental health and well-being.

Issues in Women’s Mental Health

To start, Junghans-Rutelonis told LifeScienceIntelligence what she believes to be the most significant issues in women’s mental health. Among the several topics discussed, she emphasized how gender disparities have impacted women’s mental health.

“The world continues to have ongoing gender disparities in our culture. For example, women are given far more non-promotable work tasks than men. In healthcare, inequities that exist are already exacerbated and are impacting our mental health,” she remarked.

Beyond institutional gender disparities that can aggravate mental health issues for women, there is a standard for women that involves taking on multiple roles.

“There's that connected idea of super superwoman syndrome. That phrase was coined a couple of decades ago but is so applicable now that women are neglecting themselves because they seek to do it all,” Junghans-Rutelonis expanded. She emphasized that women taking on too much is a massive challenge in mental healthcare.

Effective Conversations Around Women’s Mental Health

Throughout the conversation with Junghans-Rutelonis, LifeScienceIntelligence asked how healthcare professionals can facilitate more effective discussions on women’s mental health.

“Part of that is valuing the benefit of that interdisciplinary collaboration and realizing healthcare professionals can learn so much from each other. With releases of information in place and the ‘Okay’ from our patients, we can collaborate to better understand the biopsychosocial model and those different components of how somebody is doing with their physical and mental health. That can start with just talking about mental health and working together for change,” she responded.

Beyond interdisciplinary communication, Junghans-Rutelonis explains ways primary care providers and other medical professionals can facilitate in-depth conversations about mental health.

She believes there is more to it than asking about general mental health. “If a doctor or nurse practitioner sees a woman in their office and asks them, ‘How are you doing?’ they're going to say, ‘Fine.’ So, ask more in-depth questions,” she stated. “Get training on the mental health questions to ask if necessary. And then, healthcare professionals can work together to be fierce advocates for better mental healthcare access and coverage.”

While Junghans-Rutelonis emphasized the importance of integrating mental health screenings into primary care, she acknowledges the challenges that primary care providers may face.

“It's important to note that primary care physicians have so much on their plates. They can't be expected to be experts on mental health and everything they are accountable for. While they need to be aware, they don't have to carry all of it on their shoulders,” she shared. Training and healthy professional relationships with mental healthcare providers can help primary care providers improve how they handle mental illness.

Barriers to Accessing Care

Junghans-Rutelonis also discussed barriers to women’s mental healthcare with LifeScienceIntelligence and identified three primary barriers: logistics, insurance, and stigma.

Logistical Barriers

The first concern she identified is the logistical barriers to getting to a mental health appointment. She explains that getting to an appointment with a licensed professional is time-consuming. Considering women’s many roles and busy lifestyles, accessing care can be difficult.

Junghans-Rutelonis explained that there had been some efforts to minimize this barrier.

“The field has made big advances with PSYPACT, the Psychology Interjurisdictional Compact. It's an interstate compact that's designed to facilitate the practice of telepsychology across state boundaries. It is in 31 states, with more on the way. It allows psychologists and clients to find time to work together in a virtual way across state lines that's much more feasible than it was in the past,” she shared.

Insurance

In addition to logistics, insurance issues play a significant barrier to mental healthcare accessibility.

“The mental health insurance system in this country is broken, and healthcare professionals need to work together to help advocate for improvements,” she pointed out.

Mental health coverage varies by insurance company, but many insurance companies do not recognize patient–provider fit as an essential part of adequate mental healthcare.

“There have been decades of research on the most important component of therapy for therapy to be successful and its fit between the mental health clinician and the client. But the healthcare industry is not basing access and coverage on that reality,” noted Junghans-Rutelonis.

Coverage is a critical barrier that prevents patients from seeking mental healthcare. She stated that “behavioral or mental health office visits are five times more likely to be out of network than primary care. There is an access problem within insurance companies.”

Even when patients find an in-network provider, there are limitations on what is covered, and reimbursement rates fluctuate, which causes difficulties for the provider.

Stigma

“The third big barrier is stigma. Professionals have talked about mental healthcare stigma for a long time, but it's still there. It is important to normalize mental healthcare. It's just part of taking care of health. Mental and behavioral well-being are linked to physical health. Healthcare professionals need to take these two ideas of health and better understand how our biology, psychology, and social and cultural realities are intertwined,” argued Junghans-Rutelonis.

Reproductive Rights and Mental Health

During the conversation with LifeScienceIntelligence, Junghans-Rutelonis touched on the significant impact of policy on mental health. In recent months, as the uncertainty around reproductive rights has continued to fluctuate, those carrying an unwanted pregnancy are suffering beyond just the physical repercussions of forced pregnancy.

Outcomes of Unwanted Pregnancy

During the conversation, Junghans-Rutelonis cited the Turnaway study conducted by UCSF, which examined the outcome of nearly 1,000 people who had either had an abortion or been denied an abortion over five years.

The study found that women who were denied an abortion were four times as likely to be living in poverty than women who were able to choose. Additionally, they were three times as likely to be unemployed. Beyond the economic impacts, forced pregnancy yielded adverse mental health outcomes.

“They had more anxiety and depression and stress and physical health problems. They were more likely to have economic difficulties like bankruptcy, eviction, and lower credit scores,” shared Junghans-Rutelonis.

She expanded that “the kids born to these women had poor bonding and attachment to their mothers. They had social and emotional problems that lasted into adulthood and more psychiatric hospitalizations than their siblings or kids from wanted pregnancies.”

Fear

Junghans-Rutelonis shared an anecdote from the American Psychological Association Annual Conference, where she attended a panel that featured Candice Harkins, an associate professor at the University of Kentucky.

“She was part of a panel on the impact of the Supreme Court decision on women, and she made a fantastic point. That's that the result of all of this is fear. It's a fear that women feel during mental health appointments. It's a fear women feel during medical appointments with professionals because they don't have the autonomy and a safe space to discuss their healthcare options,” she revealed.

The impacts of fear can be severe. Junghans-Rutelonis indicated, “when somebody must live in fear, their stress system revs up, and it stays in that revved up mode. That has physical and mental health repercussions for their immune system and behavioral health.”

Provider–Patient Relationships

In addition to the direct impacts on mental health that policy changes have caused, it has also strained patient–provider relationships as many states are requiring all healthcare providers to report illegal abortions.

“It puts mental health professionals in a very challenging place where our license can now be on the line just by doing our job. As a psychologist, my job is to put the health and safety of my patient first and to create a safe space for her to build trust and to have that fit that she can trust,” stressed Junghans-Rutelonis. “There are states now where mental and physical health professionals can no longer do that. There will be a ripple effect of this on women for a long time.”