The problem of mental illnesses is a thorny health issue to deal with. The term "mental health care" has been widely used to denote a wide variety of services, varying from frequently used services, for example, marital and family counseling, to precise therapy alternatives for chronic mental conditions, such as bipolar condition (Lierberman et al., 2017) . In America, mental health problems have been undertreated, under-researched, and over-stigmatized. Despite this, approximately 26.2% of Americans 18 years and above and one in four adults or 57.7 million individuals ail from a diagnosable mental disease every year (Lierberman et al., 2017) . More emphasis has been placed on the earnestness of bettering mental healthcare because of the several factors that may lead to mental illness. These factors include; homelessness , imprisonment, opiate addiction together with other several factors. There several types of mental illnesses; however, the most prevalent forms include depression, autism, bipolar conditions, schizophrenia, and Alzheimer’s disease (Lierberman et al., 2017) . These groups of people suffer extreme disability and distress and require a high level of expensive healthcare services, and have substantively shortened lifespans because of excess medical comorbidity and heightened suicide rates (Lierberman et al., 2017) . Hence, this article focuses on the availability of mental healthcare in the United States, deficiencies in mental health and addiction, and the step taken to improve mental healthcare.
Deficiencies in addiction and mental health services are enduring and profound in America. The deficiency in these services cannot simply be considered as unmet medical needs or disparities in health care: these deficiencies in services signify what ex-Congressman Patrick Kennedy labeled as a " violation of civil rights ” (Lierberman et al., 2017). Congress has constantly been engaged in transforming the mental health system, especially after the shooting incidences at Virginia Tech, Columbine, and the Newton school. The shooting incidences increased public interest after an investigation found that the shooters involved had mental health problems (Lierberman et al., 2017) . Due to unmet mental health needs by the shooters, many people have called for a stouter mental health safety net to minimize the incidences of gun shootings. By increasing ease of access to mental health services, the reason goes; professionals like psychologists and psychiatrists can play an intervening integral role before a tragedy takes place.
Delegate your assignment to our experts and they will do the rest.
In the U.S, the mental healthcare system is a multibillion-dollar industry; nonetheless, it is not adequate to serve all the people who need its services. The economic burden of mental illness is substantial. In 2010 the approximated yearly cost of depression amounted to $210.5 billion. The cost included both indirect and directs costs, for example, death due to suicides associated with depression, in addition to the effects of depression at places of work (Lierberman et al., 2017) . In 2013, the cost of opioid use disorder was projected at $78.5 billion. Moreover, the Substance Abuse and Mental Health Services Administration (SAMHSA) approximates that substance abuse and mental disorder therapy cost from all private and public sources covering only direct costs will increase to $280.5 billion by 2020, a rise from $171.7 billion in 2009 (Lierberman et al., 2017) . The projected figures do not incorporate the extra expenses to the criminal justice system, which accommodates huge populations of individuals with insufficiently treated mental disorder and substance abuse disorders.
Costs of mental health treatment form a major barrier in the treatment of diagnosable mental health disorders. However, the major problem is the attitudes about mental health, which prevents people from seeking early treatments. Generally, society has a negative opinion of people who have a mental illness (Mascayano et al., 2016) . The stigma associated with mental health is exhibited by distrust, bias, stereotype, anger, embarrassment, avoidance, and fear. Stigma is a huge barrier that disheartens people from pursuing therapy, expressly in rural regions. To address stigma, there is a necessity to transform the perception of the society on mental health by availing effective therapy alternatives (Lierberman et al., 2017) . Besides, providing a positive attitude towards recuperating people with a mental health condition and improve social awareness that mental disease is not only prevalent but treatable.
Perfecting mental health care in America has been a bipartisan matter. In 2002 President George W. Bush convened The New Freedom Commission, which acted as an alarming signal for future leaders to seek dramatic enhancements in the delivery of mental healthcare (Lierberman et al., 2017) . Nonetheless, stigma, fragmentation, and immobilized budgets greatly disenchanted this effort. After then, several laws have been made such as the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), in addition to former President Barack Obama’s healthcare reform bill, Affordable Care Act and the Patient Protection (Kliff, 2015) . These regulations have enabled to push forward the expansion of mental healthcare and substance abuse services (Lierberman et al., 2017) . Though, previous efforts to tackle unmet public mental health demands have not flourished in achieving their goals of comprehensive access to quality care.
However, recently, it has been changing, and a lot of attention has been focused on the issue of mental health. Care of people with mental illnesses has been a concern for the public for some time because these are highly prevalent and highly disabling medical conditions (Kliff, 2015) . Majority of individuals in America with mental disorders require treatment, but they do not receive it. There are several mental healthcare providers in the U.S with ranging levels of expertise (Mascayano et al., 2016) . Mental healthcare providers can be grouped into four groups depending on the care they offer. They include highly trained providers, social service providers, generalists, and informal volunteers. The settings of mental health care may be at an outpatient clinic, hospital, or an informal venue. The magnitude of a person’s mental health can influence the setting in which mental care is provided (Mascayano et al., 2016) . Though mental illness maybe managed using therapy on outpatient, however, the severe mental disorder may preclude a person from being an active member of the society. For example, the kind of mental healthcare issued to a person ailing from mild depression or mild eating disorders would differ from that given to a person suffering from extreme bipolar disorder.
Reduction of uninsured adults through the improvement of access to insurance and treatment policies, especially through Medicaid, has slightly improved the mental health care system. However, mental health care in America hasn't been as effective as it should be considering that it is a first world industrialized country (Lierberman et al., 2017) . The mental health care system in America is literary "broken," and due to this, a large number of the American population has been adversely affected. Services of mental health care in America are lacking.
A study conducted in Washington in 2011, established that Multidimensional Treatment Foster Care (MTFC), which focuses its therapy on family and youth, has enabled the government saves more than 5$ of the juvenile delinquency costs (Kliff, 2015) . Reduction of instability in the foster care placement system, according to Oregon, a lot of costs have been saved. Howler, despite the effectiveness of this program, a 2017 study report established that very few foster kids suffering from mental illnesses participate in the MTFC program (estimating less than 5%) (Kliff, 2015). An attempt to restore the foster care system in a 2016 bill that managed to pass the house but was thrown out of existence in the Senate shows how difficult it is to improve the mental health care system in America.
The state of psychiatric care provided to prisoners in America is very poor. Compared to other countries in the world, the United States has the most significant number of inmates in prison. According to the study conducted by Al-Rousan et al., 2017 , a jail that has a psychiatric facility had more mentally ill inmates, the number that could be found in a hospital. Furthermore, it’s a common practice in United States jails, to place mentally ill patients in solitary confinement which according to medical professionals deteriorates the symptoms of a mental disorder (Al-Rousan et al., 2017) .
A few people in the low socioeconomic status can afford the treatment expenses linked with mental disorder despite the excellent progress that has been made in the establishment of psychological interventions that are highly efficient for mental illnesses. About 40% of mentally ill individuals in America are unable to access mental health care (Kliff, 2015) . Additionally, there are several steps that the government has recently taken, which may worsen the problem. For instance, cuts made to Medicaid may have serious implications because it's estimated that more than 40% of the Medicaid expansion recipients are victims of mental illnesses (Durbin et al., 2016). Medicaid expansion is under the Affordable Care Act, which has undergone numerous alterations; the most crucial one about mental health care is the permission of the sale of insurance policies that were initially free of essential benefits. Hence, this would result in mentally ill patients having to use emergency rooms for primary mental health treatment. It is apparent such issues has resulted in a deterioration of the mental health care system in America
The National Institutes of Mental Health (NIMH) is the organization that is mandated with the duty of funding mental health research. However, several scientific types of research conducted on efficient strategies of treatment of mental diseases in the past have been ignored (Kliff, 2015) . It is crucial to recognize that NIMH only funds less than 20% of the research proposals presented to them. Hence, most researchers are discouraged from engaging in mental health research. Therefore, minimal information on effective mental healthcare is discovered. As a consequence, the absence of such research makes it impossible even to use evidence-based methods of treatment to care for the mentally ill (Kliff, 2015) . Moreover, limitations in the field of social science research have cost America the progress required for improvements of the mental healthcare systems.
Also, America is experiencing an extreme shortage of mental healthcare professionals. In the U.S approximately a single mental health personnel provides service to more than six mentally ill patients. As a result, poor service delivery to patients is experienced, and some patients are not able to receive healthcare at all (Kliff, 2015) . The shortage in the workforce has made it a challenge for the health professionals to execute evidence-based solutions to the treatment of mentally challenged clients. Nonetheless, dire the situation is there are efforts that have been initially implemented to reform the mental healthcare system. For example, the Obama administration in November 2013, commands directives that mental health care is covered by all American insurance plans (Lierberman et al., 2017) . The intended consequence of these legislations was that people would be able to receive mental health care in the same way other forms of medical care were being issued and covered by insurance companies.
However, the directive by President Obama did little to solve the crisis with mental health care since the reach of these services has been difficult. It is with no doubt that the mental health care system in the U.S has been in a total crisis in the past few years. Most Americans are unable to gain access to indispensable mental health care necessitated due to the various established reason (Kliff, 2015) . Hence the medical health care in America has continued to be insufficient to handle the current influx of mental health patients.
Therefore, several steps need to be taken to make sure the health care system gets out of the problems that the mental health care system is facing (Durbin et al., 2016) . It has been established that there are certain groups of people who are more vulnerable to mental health problems. The first step to ensuring that the situation doesn’t get out of hand is the creation of a children's welfare system for the children who are deserted, neglected, or abused. However, what affects the effectiveness of such a system is the fact that in most cases, it is overwhelmed and underfunded. Moreover, foster care children need to have heightened mental health care. This is a multidimensional treatment foster care (MTFC), whose main aim is to focus on both family and youth therapy (Durbin et al., 2016).
The fact that mental health treatment services remain unaffordable an unreachable to many is an issue that needs to be looked at. Countrywide, there is an availability of mental health services (Durbin et al., 2016) . However, only a small fraction of people can acquire treatment due to the high costs and structural failures such as limited transportation access. Effective ways can be provided, which can help solve these problems. For instance, the problem with limited transportation can be curbed by considering the new technological advances which psychotherapy via phone and online clinical interventions (Durbin et al., 2016) . Unaffordability of mental health care, especially for the disadvantaged groups, can be reduced through various actions such as the establishment of insurance policies that can fully cater for their treatment. Amendments to the current legislation with regards to mental health care financing will help improve the financial burdens faced by the mentally ill and their relatives.
As illustrated above, the financial burden of substance abuse and mental illness for both the private and public payers in addition to subsidiary social services and the criminal system of justice should be a primary incentive for advocating for a redesign of payment (Lierberman et al., 2017) . Amendments to the current legislation can embolden the placement of financing structure of insurance companies to fresh models of mental care and services delivered by health practitioners (Lierberman et al., 2017) . Though the initial aim will be to reimburse to personnel's from various professions, the final cost will be included into new models of payment, not excluding risk-adjusted, bundled payments and population-centered payments (Lierberman et al., 2017) . Measurement based-care, in which therapy is linked to outcomes, has already been established for the management of hypertension, CHF, diabetes, and non-psychiatric medical illnesses. The same model can be used in the mental healthcare structure and embedded in its models of payments. The National Academy of Medicine has provided basic directives, which advocates for enhanced and creative models of payment that support evidence-grounded treatment methods.
The successful operation of mental healthcare demands for coordination and connection between public and private entities, numerous specialty services, and a variety of institutions in education, criminal justice and housing (Al-Rousan et al., 2017) . Imprisoning mentally ill patients and especially confining them in solitary confinement leads to deterioration of the condition. Solitary confinement is a common practice in American prisons (Al-Rousan et al., 2017) . Besides, very few jails have comprehensive psychiatric services. Prisoners are unable to access the psychiatric care needed. This makes the situation worse, and the only viable way to make it better is to have more psychiatric services offered in prisons and jails. It is cheap to have a mentally ill patient treated in the community as compared to having them stay in jail (Al-Rousan et al., 2017) . Therefore, alternatives for dealing with the mentally ill instead of punishing them in jails need to like coordination of care between various institutions and providers can be adopted.
Improvements in scientific research, social advancement, mental health awareness, and government legislation have established a strong foundation for the revolution of the U.S mental care system. Nonetheless, these efforts are not sufficient: political guidance and measures are needed together with the backing of biomedical studies in disorders of the brain and investment in the innovation of new and effective mental health therapies. A comprehensive approach to dealing with mental health disorders needs to be enacted, to target the populations that are in need, i.e., those affected by mental health disorders. Use of evidence-based treatments is a crucial aspect of dealing with mental disorders that have not been fully studied and implemented. In his address, President Trump promised that quality healthcare delivery to American would be his topmost priority. Hopefully, that will also include mental healthcare.
Reference
Al-Rousan, T., Rubenstein, L., Sieleni, B., Deol, H., & Wallace, R. B. (2017). Inside the nation’s largest mental health institution: A prevalence study in a state prison system. BMC public health , 17 (1), 342.
Lierberman, J., Goldman, M., Olfson, M., Pincus, H., & Sederer, L. (2017). Improving Mental Health Care in America: An Opportunity for Comprehensive Reform. Retrieved from https://www.psychiatrictimes.com/cultural-psychiatry/improving-mental-health-care-america-opportunity-comprehensive-reform/page/0/2
Mascayano, F., Tapia, T., Schilling, S., Alvarado, R., Tapia, E., Lips, W., & Yang, L. H. (2016). Stigma toward mental illness in Latin America and the Caribbean: a systematic review. Brazilian Journal of Psychiatry , 38 (1), 73-85.
Durbin, A., Durbin, J., Hensel, J. M., & Deber, R. (2016). Barriers and enablers to integrating mental health into primary care: a policy analysis. The journal of behavioral health services & research , 43 (1), 127-139.
Kliff, S. (2015, December 17). Seven facts about America's mental health-care system. Retrieved from https://www.washingtonpost.com/news/wonk/wp/2012/12/17/seven-facts-about-americas-mental-health-care-system/?noredirect=on&utm_term=.d7f6899e862e
