Cognitive Bias In Health Care

As Americans it becomes natural to undermine those with a mental illness. As a fact, many adults and children deal with mental illness each and everyday. There are many stories that have been told to Americans about depression, anxiety, along with bipolar disorders, with the outcome usually being a negative consequence. For the 1 in every 5 citizens that deal with a mental illness each year. Americans have neglected the fact that many adults and children deal with mental issue(s), the citizens that refrain from getting help; their well being can suffer detrimental effects, there is not a lot of awareness either taught in school, or in public perspectives, American’s stigma has perfected their

Our progress in learning the causes and treatments for mental illness has been steady as we build on the medical model of mental illness, which Zastrow & Kirst-Ashman (2010) describe as a model that, “views emotional and behavioral problems as a mental illness, comparable to a physical illness (pp. 341). Only in modern times have we been able to effectively treat mental illness with behavioral therapy, social support, medicine, and other research-based programs. However, there is still much work to be done in regard to access, proper facilities, policy and a host of other challenges that affect this issue.

One of the biggest contributors for poor healthcare is the stigma against mental health. This stigma allows healthcare providers to view those with a mental illness as having low relevance, thus creating disinclination towards providing adequate resources and/or care. This negative stance, based on misinformation and prejudice creates those that have a mental illness to lose their self confidence. Because of this loss, people with mental illness decide not to contribute to their health or livelihood. In the past fifty years, many advances have been made in mental healthcare. However, with the attached stigma, many people choose to not seek out treatment.

According to the World Health Organization, mental illness will affect approximately 25% of people at some point in their life (“WHO Qualityrights”, n.d.). Despite that, the current mental health care system in the United States is inadequate. Many aspects of the system need improving, especially the barriers to service. In fact, approximately 20% of individuals are left without necessary treatment for their mental health disorder (“Mental Health”, 2016). Mentally ill individuals have difficulty accessing necessary mental health care services for various reasons; insurance, socioeconomic status, and mental health stigma can all function as barriers to treatment. Insurance discrimination can make it difficult for individuals to find treatment (Han, Call, Pintor, Alarcon-Espinoza, & Simon, 2015). Gaps in insurance coverage can also be a barrier, as they disrupt the long-term treatment process (Gulley, Rasch, & Chan 2011). Socioeconomic status has been found to negatively affect appointment scheduling (Kugelmass, 2016). Finally, stigma in our society can also stop people from seeking out treatment that they need (Bathje & Pryor, 2011). The mental health system in the United States is not capable of caring for the mentally ill, as insurance, socioeconomic status, and perceived stigma all act as barriers that prevent people from receiving the treatment they need.

Mental illness is nondiscriminatory, can affect any person and transcends all social boundaries. As a result, the issues surrounding mental illness have become common discussion pints among policymakers dedicated or required to formulate solutions around providing the long-term care needed by many patients. Healthcare reforms and changes to the systems that provide services to those living with mental illness and funding for services to the facilities providing care have become major social issues (Goldman, Morrissey, Ridgley, Frank, Newman, & Kennedy, 1992). The reason for this is primarily how it can affect a market economy and how much of a burden diseases of the mind can be in a country such as the United States. According to the 1991 Global Burden of Disease study conducted by the World Health Organization mental health burden accounted for “more than 15% in a market economy such as the U.S.” (The Impact of Mental Illness on Society, 2001). The study also states that for individuals over the age of 5, varying forms of depression are the leading cause of disability. A more recent study indicates that mental illness in general is found in more than 26% of the United States adult population, of which 6% are severe and limit the patient’s ability to function (Martin, p. 163. 2007).

“A mental disorder (mental illness) is a psychological pattern that is generally associated with a defect or disease of the individual’s mind. It causes a disability that may affect an individual’s behavior patterns in ways that are not part of one’s normal development or culture. Mental disorders are common in the United States. Within any given year, nearly 25 percent of adults and slightly over 20 percent of children are diagnosable for one or more mental disorders. While mental disorder appears to be widespread among the population, the main burden (or threat) emanates from about 6 percent of those who suffer from a debilitating mental illness.” (National Institute of Mental Health, 2011)

The emphasis on the dangerousness of the mentally ill has only helped fueled the stigma against mental illness in America, harming those who need help the most. Although the stigma against mental illness in America is perhaps comparatively weak when compared to the stigma in developing countries or Asian countries, it is strong enough where “despite the availability of effective evidence-based treatment, about 40% of individuals with serious mental illness do not receive care and many who begin an intervention fail to complete it” (Association for Psychological

“Despite many calls for change, mental health care continues to be separate from the rest of health care. Difficulties in accessing mental health care have become a “de facto” in the US. Although screening for mental illness in primary care has increased in recent years, subsequent treatment remains inadequate and referral for specialty treatment continues to suffer from long delays. In the National Comorbidity Study, only 21.7% of individuals with major depressive disorder received adequate treatment (Grembowski, 2002).”

Through environmental and technological innovations, health care in the industrialized world has been transformed over the past two centuries. This transformation also applies to mental health care. With the discovery and acceptance of psychology as a legitimate health science in the past one and a half centuries, mental health has been gradually integrated into the broad health care schema as primary and preventative medicine. However, even with this gradual integration, mental health care in the United States leaves much to be desired. Even after the passage of the 2010 Patient Protection and Affordable Care Act (ACA), this type of care falls short of

The CDC reported only 20% of US adults went to a mental health provider in the past year. The other 80% were too ashamed and embarrassed to be associated with getting help. Society has shaped an image of the perfect person, and people with mental illnesses don’t believe that they fit that mold, because of this, they aren’t willing to seek help and instead turn to dangerous coping methods. Some of these coping methods include, smoking, drinking, drug use, binge eating, cutting, and possible suicide. These methods can cause chronic disease and premature death. According to the National Alliance on Mental Illness, those living with serious mental illness die an average of 25 years earlier than the general public, primarily due to treatable conditions. Due to the stigma of mental illness, people are treated wrongfully and are discriminated against, causing them to not get proper care. This discrimination causes people to have unequal access to housing, healthcare, employment, education, and community support, and can lead to unemployment, homelessness, and poverty. With all of these unfair and unjust barriers, it’s not hard to figure out why people wait so long to get diagnosed.

Mental illness is a major burden on society that is not given enough attention or resources, especially in the United States. The continued neglect of these needs concerning related conditions dates back to the beginning of history, while diagnoses and the need for adequate care have only continued to rise. These inequalities in the United States mental health care system create enormous ethical challenges for these individuals in receiving health care. “In 2007 about 11% of adults (23.7 million) in the United States experienced serious psychological distress, such as anxiety and mood disorders, that resulted in functional impairment that impeded one or more major life activities” (Sundararaman, 2009,

In today’s society there is a greater awareness of mental illnesses. With this greater awareness one might assume that there would be a substantial increase in government involvement or funding in the area of mental illness treatment. Unfortunately this isn’t the case in the U.S. today. There are hundreds of thousands of people with mental illness that go untreated. These potential patients go untreated for many reasons. These reasons are discussed in the Time article “Mental Health Reform: What Would it Really Take.

Every year, as many as 8 million Americans who have serious mental illnesses do not receive adequate treatment. Kelly, a mother of three, has battled depression for 15 years. Her psychiatrist tried to have her admitted, but there was not a single available bed. Not in the city, not in the entire state. Kelly is one of the millions of people who were turned away from services. “States looking to save money have pared away both the community health services designed to keep people healthy, as well as the hospital care needed to help them heal after a crisis” (Szabo). Thomas Insel, director of the National Institute of Mental Health, states that mental illnesses cost the country at least $444 billion a year, with only one-third of it going towards medical care. States should better fund mental health care because it has been neglected, it is a vital part to a person’s overall health, and it should be listed as a priority.

In order to reduce some of the confusion technical support was provided by the government. Although, hesitation occurred initially Obamacare has now provided nearly all Americans with the proper health coverage. According to Benefits Of ObamaCare "15% of Americans who do not currently have coverage will be able to access quality affordable health insurance" (2016). Two types of decisions making skills help consumers make the best choice, routine decision making and complexed decision making. Routine decision making is based on day to day familiar choices and decisions. An example of routine decision making is when a consumer makes an appointment for their yearly medical check ups that does not involve extraordinary circumstances. Whereas, Complexed decision making is involved when patients research possible insurance plans that they do not have current in-depth knowledge about. Complexed decision making involves a level of uncertainty and confusion which leads to in-depth research. An Example of complexed decision making would be the selection process of picking a surgeon to preform a risky surgery. Complexed decision making is often a long process due to the lack of personal

inaugurated a new wave of research both re-examining the body of knowledge regarding bias, and applying it to provider-patient interactions.