Organization wants investment in healthcare, not jails

While mental health can sometimes be seen as a taboo topic, mental illnesses are among the most common conditions in the country. In fact, the Centers for Disease Control and Prevention reports that more than 50% of people in the United States will be diagnosed with a mental health disorder at some point in their life.

For those suffering with a mental health issue, finding proper care and beginning that conversation can be a challenge — especially in rural or poor communities with limited resources.

"Access to mental health care is extremely low in the community that I work in, especially because people don't have access to health insurance. They're unable to pay for any services that do exist, but also because of this lack of sort-of health infrastructure, there are long queues for therapists, psychiatrists, and primary care providers that will see patients who are uninsured in the community," said Dr. Laura Ucik, a family doctor in Henderson, N.C. "People with severe PTSD, people with schizophrenia, people who are hearing voices or having panic attacks and feeling like they're going to die — they aren't able to access healthcare providers or therapy, which is one of the first-line recommended treatments for any mental health condition."

In her position as a doctor in a town of just under 15,000 people, Ucik has seen first-hand how this lack of access impacts those who suffer from mental health issues. According to Ucik, it's often difficult for these individuals to hold consistent jobs, maintain relationships with family and friends, and even stay calm in public places.

"If something goes wrong in public, then police get called, because that's one of the only options in an emergency, and they go to jail. Then they have a thousand, two thousand dollar bail that nobody is able to afford. They're in jail for a long time, which is incredibly traumatizing and destabilizing, especially for somebody with a preexisting mental health condition," said Ucik. "In fact, people with mental health conditions are in solitary confinement at much higher rates, because they don't do well in the general population. They're having panic attacks because they have PTSD, so they spend months by themselves in a cell with no other human interaction, which only destabilizes them further."

For these individuals, by the time they're released from prison, the conditions inside may have only exacerbated whatever mental health issues they were already dealing with. Oftentimes, the work they've done and support systems they've had in place have dissolved.

For Ucik, this leads to a vicious cycle that often sees people returning to prison or turning to dangerous coping methods. Extending access to medical care could help address some of these issues.

The period of time directly after people are released from prison is a sensitive window, and according to Ucik, the rates of death in those few days are unusually high. Oftentimes, these deaths are caused by overdoses from substance use disorders — a condition which Ucik likens to diabetes due to its similarities to being both genetically and environmentally influenced.

There are effective treatments for people who struggle with substance disorder, including suboxone or buprenorphine. These treatments can help prevent relapses while also reducing the likelihood of contracting diseases like Hepatitis C or HIV. Currently, however, prices for these medications range anywhere from $90 a month to $300 a month.

"If we invested in healthcare and mental health care services at the very beginning, it would certainly save money, it would save everybody a lot of time, and it would alleviate so much suffering. A lot of the issues that lead to people being incarcerated for mental health reasons or for substance use reasons could easily be prevented if somebody had access to primary care," said Ucik. "There are many reasons that people in the rural community that I've worked in can't access primary care. When 70 percent of our patients are uninsured, there's really nowhere else for them to go if they don't want to pay $200 or $300 out of pocket to see a healthcare provider."

For Ucik and a number of other rural healthcare providers, expanding Medicaid could help alleviate some of the issues around healthcare access and incarceration rates.

"If we expanded Medicaid, I know there's a concern that suddenly people would then flood all of the healthcare offices, and it would overwhelm the system. But people are already overwhelming the emergency rooms and urgent cares and the very few federally funded assessors that there are — and extending Medicaid would basically provide the financial backing for other providers to start seeing these patients," said Ucik. "It would really increase access, and it would also increase funding for these clinics so that we could hire more providers to see more patients. When somebody calls and says, 'I'm having a crisis, I need to see a doctor,' they can get a different response than, 'Hey, we'll put you on our wait list for the next three months.'"

While Medicaid expansion and healthcare in general is a hotly debated topic in the political arena, doctors like Ucik see it as a necessity in addressing the needs of communities across the country.

"By continually expanding the prison system, it's like sticking a finger into a gaping wound — all it does is create more harm. By incarcerating somebody who is dealing with substance use or a serious mental health issue, it only makes that issue worse," said Ucik. "They come back, they're in the same position that they were before, but they're just more traumatized. Investing in healthcare and Medicaid expansion will have a massive ripple effect in improving the wellbeing of our communities."