In rural states such as North Dakota, accessing mental-health care can be extremely difficult. Federal officials say it's even worse when someone's benefits for such care are improperly denied.
They're ramping up enforcement under a law aimed to address the issue.
The Mental Health Parity and Addiction Equity Act, in place since 2008, requires most health plans - offering coverage for behavioral health or substance use disorders - to not make those benefits more restrictive than those for standard medical care.
Lisa Gomez, assistant secretary for the Employee Benefits Security Administration, said their investigations have found that providers are still falling short in providing equal access.
"For example," said Gomez, "there were plans that were excluding coverage for nutritional counseling, if you were seeking that coverage for an eating disorder."
However, the plan in question was not restricting coverage for those seeking that type of counseling for help with a physical health issue such as diabetes.
In fiscal year 2022, Gomez's agency investigated nearly 150 plans and found almost two dozen violations.
An EBSA report suggests correcting these situations is significant because in some cases, hundreds of plan participants were affected by a single provision not in compliance.
Report authors say forcing the provider to make good on the claim can be a life-changer for those struggling with a mental-health issue.
Gomez said for underserved populations, such as rural areas, getting rid of obstacles helps that individual make their situation more manageable.
She added that the last they need is to have to wait for something like a co-pay error to be sorted out.
"We've seen what mental-health conditions and substance-use disorders can do to a person, to a family," said Gomez. "And so, it's really important that we try to use the tools that we have available to us and work together to try to address these issues."
Gomez acknowledged that while there is progress, it isn't moving fast enough to remove these specific coverage hurdles.
Various federal agencies are trying to finalize proposed rules that would strengthen provisions under the law.
Outside of benefits roadblocks, Kaiser Family Foundation data show that in North Dakota, only 19% of mental-health care patients' needs are being met due to provider shortages.
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In the past year, the Colorado AgrAbility Project added four behavioral health specialists to help the state's agricultural producers, workers and families who face unique stressors and health risks, including higher rates of suicide.
Chad Reznicek, behavioral health state specialist for the project, said stigma continues to be a barrier when it comes to seeking help for mental or behavioral health but he hopes farmers understand the equipment between their ears is more important than any high-dollar piece of equipment in their operation.
"Because if things aren't going well there, it's really hard to be effective, efficient, resilient and creative in how you're addressing all these other factors that someone has to juggle while they are involved in agriculture," Reznicek pointed out.
For more than 30 years, the Colorado AgrAbility Project has helped farm and ranch families maintain their agriculture lifestyle in the face of physical challenges, limitations, and disabilities. After Colorado lawmakers expanded the project's scope in 2021, more than 1,500 people in rural communities have been able to connect with behavioral health care, stress management resources, and suicide prevention initiatives.
Farmers can access six free therapy sessions with counselors who understand the pressures facing producers, including volatile commodity pricing, drought and extreme weather events, pests and disease. Reznicek emphasized the sessions are anonymous and can be accessed remotely.
"We have providers that will be in their office talking to someone that's actually in the cab of their tractor, if that's what best serves them," Reznicek observed.
The project has conducted anxiety and stress management trainings for students, and workshops for the Colorado Young Farmer and Rancher conference and 4H groups. Reznicek added with farmers' average age now over 60, families can also get help as they face the challenge of creating succession plans.
"And that's great if you've got the time, the resources, the planning and the relationships to make that effective," Reznicek noted. "If not, it becomes incredibly stressful."
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By LaGanzie Kale for KLEK-FM.
Broadcast version by Freda Ross for Arkansas News Service reporting for the KLEK-FM-Winthrop Rockefeller Foundation-Public News Service Collaboration.
In a significant community conversation on 102.5 FM, host LaGanzie Kale delved into the mental health challenges faced by ALICE (Asset Limited, Income Constrained, Employed) populations in Northeast Arkansas. Joined by Kenya Ward, LCSW, the discussion highlighted the unique struggles and mental health implications for these hardworking yet financially strained individuals.
Understanding the ALICE Population
ALICE populations include individuals and families who, despite being employed, struggle to meet basic needs due to limited assets and constrained incomes. These individuals live above the federal poverty line—approximately $12,000 for individuals and $24,000 for a family of four—yet they face significant financial challenges in covering essential expenses such as housing, childcare, and debt payments.
Kenya Ward emphasized that about 31% of Arkansas’s population falls into the ALICE category. “These are hardworking people living above the poverty line,” she explained, “but they still have a great deal of difficulty making ends meet and getting their basic needs met.”
Financial Stress and Mental Health
Financial stress significantly contributes to mental health issues among ALICE populations. The constant worry about finances can lead to severe mental health conditions, including depression and anxiety. Ward noted, “One in five Americans will experience some form of mental health issue in their lifetime,” highlighting the prevalence of these conditions.
Current inflation only exacerbates these challenges, with rising costs for necessities like food, clothing, shelter, and gas, while wages remain stagnant. Ward pointed out that even though wages might increase minimally, it is often not enough to make a substantial difference in alleviating financial stress. “This creates a vicious cycle of financial strain and mental health deterioration,” she said.
Manifestations of Mental Health Issues
Depression and anxiety are the most common mental health issues observed in ALICE populations. Ward described how depression might manifest differently between genders. In men, it often appears as anger or irritability due to societal pressures to provide for their families despite insufficient income. “Many times, men feel like it’s safer to demonstrate anger than to show sadness or grief,” Ward explained.
For women, depression and anxiety might present as feelings of hopelessness and helplessness, compounded by the need to balance work and household responsibilities. The constant struggle to make ends meet can lead to significant mental health breakdowns, affecting their overall well-being and productivity at work. This reduction in productivity further jeopardizes their financial situation, creating a cycle of stress and mental health decline.
Barriers to Accessing Mental Health Care
Several barriers prevent ALICE populations from accessing adequate mental health care. Ward highlighted the stigma associated with seeking mental health treatment, lack of time, and being underinsured or uninsured. Many insurance plans require high deductibles before covering mental health services, making it financially unfeasible for many families to seek help.
“People often feel guilt or shame when seeking mental health treatment,” Ward said. “It takes time to dispel these myths and break down the walls of stigma.”
Available Resources and Support
Despite these barriers, resources are available to help those in need. Ward mentioned pro bono sessions, sliding scale fees, and the possibility of working with interns at therapy agencies who can provide free or low-cost services. She emphasized the importance of overcoming the stigma and seeking help, as early intervention can significantly improve mental health outcomes.
Additionally, Ward discussed the role of psychotropic medications in treating mental health issues. While these medications have side effects, they can be a valuable temporary coping strategy to help individuals manage symptoms of depression and anxiety until they can develop more sustainable coping mechanisms through therapy.
The Impact on Productivity
Ward also discussed the impact of mental health issues on productivity. “If your mental health is suffering, you really don’t want to be around people,” she explained. “Most times, you really want to be alone. You want to kind of retreat and withdraw.” This withdrawal can lead to increased absenteeism, lower productivity, and even job turnover, further exacerbating financial and mental health challenges.
Lower productivity and frequent call-ins due to mental health issues can significantly affect the income and job stability of ALICE populations. This, in turn, perpetuates their financial difficulties, making it even harder for them to escape the cycle of financial strain and mental health struggles.
The Role of Therapy
Therapy can play a crucial role in helping ALICE populations cope with their mental health issues. Ward emphasized the importance of seeking help from mental health professionals who can provide diagnosis, develop treatment plans, and offer therapeutic interventions. She also mentioned the benefits of psychotropic medications, which can help manage symptoms and improve mental health stability.
Ward highlighted several resources available to those in need, including pro bono sessions, sliding scale fees, and therapy interns who can provide low-cost services. She also encouraged individuals to seek support from local therapists and mental health agencies.
Call to Action
The conversation concluded with a call to action for those in need to seek help from local therapists. Ward can be found at Jackie Scope Therapy, and there are numerous other mental health professionals in the Jonesboro and Northeast Arkansas area. Seeking help can provide much-needed support and relief for those struggling with the dual burden of financial and mental health challenges.
LaGanzie Kale encouraged listeners to take the first step towards mental wellness. “Help is out there,” he said. “Just do a Google search, find the right therapist for you, and get the help you need. Therapists would rather see you struggling but getting help than to just give up.”
Kenya Ward’s message resonated deeply, emphasizing the need for both individuals and policymakers to address the interconnected issues of financial stability and mental health. By providing support and resources, communities can help ALICE populations overcome their challenges and improve their overall well-being.
For those of you listening, if you or someone you know is struggling, please seek help. Local therapists like Kenya Ward at Jackie Scope Therapy are available, and there are many resources out there. Let’s work together to support our ALICE populations and ensure they receive the help they need.
This community conversation serves as a vital reminder of the challenges faced by ALICE populations in Northeast Arkansas. It urges all of us to take action, provide support, and advocate for policies that address the root causes of financial and mental health struggles. Together, we can make a difference.
LaGanzie Kale wrote this article for KLEK-FM.
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A new law just took effect in California, giving children on Medi-Cal age 12 and older the right to consent to mental health care on their own.
Before, only young people on private insurance could consent to outpatient mental health services independently of their parents, and only in cases where abuse is suspected or the child is in danger of self-harm.
Joy Alafia, executive director of the California Association of Marriage and Family Therapists, said there are close to 6 million youths on Medi-Cal.
"For communities of color, we're looking at 61% of African American children, 59% of Latine children, and 38% of Native and Indigenous children who are Medi-Cal recipients," Alafia reported.
Supporters see it as an equity issue, allowing kids to get help for anxiety, depression and suicidal thoughts regardless of their income. Opponents, including the Pacific Justice Institute, argued the law gives counselors too much power at the expense of parents, particularly parents with traditional religious beliefs regarding gender expression.
Alafia noted a law allowing kids with private insurance to seek mental health care without their parents' consent is about 10 years old now. She explained the new law expands the right to kids on Medi-Cal and still requires parental notification if the child wants to go to an overnight shelter.
"This is about children being able to seek support and it's not an intention to exclude the parents," Alafia emphasized. "Unless there's a concern about safety or harm to the child. Other than those scenarios, there is engagement with the parents as well."
Families in need of mental health assistance can call the California Parent and Youth Helpline at 855-427-2736.
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