Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.
Today's article is indicative of how badly the US healthcare system needs reforms. There are a lot of failures in the supposed "best healthcare system in the world," which we'll discuss here. The study focuses on mental illness in children. The healthcare system affects autistic people quite a bit, and mental illness often goes hand-in-hand with developmental disabilities. So, let's begin.
First, this study was done entirely using the data of privately insured children with mental illnesses. So, everyone they looked at had non-Medicaid or Medicare insurance. This isn't often the case for autistic people, because the cost of supports often goes well beyond most family incomes. Restricting the study data lets us see trends we might otherwise miss, though, which is why it was done.
Second, many of the studied children were in areas with sufficient doctors to serve their needs. In rural areas, this is not always the case, and one doctor may be the only doctor for 20 miles. Since a human can only retain so much information and there are a great deal of ailments, medical and neurological, substandard care can result. For this study, this lack was mainly not an issue either.
With both these facts in mind, let's now look at what happened. Each of the roughly 200k children had their first "I seem to be experiencing mental illness" doctor visit. It is both appropriate and important that a follow-up appointment be made and treatment options discussed with the child and their parents.
...So naturally, about 30% of these children didn't have that follow-up appointment. Failure 1: just having a "yep that sure is mental illness" does not help the person cope with the condition or improve their life. 30% is on average by the way. Some ZIP code areas were as bad as 50%. So you literally had a coin toss' chance to receive help.
Now, on to the content of those follow-up visits. Our best understanding of how to start treating mental illnesses is that you begin with therapy. Many insurances cover a certain number of appointments with a therapist, though not always. I don't personally think there should be a limit, but that's all in the name of "not wasting healthcare on people that don't need it" or something. Spoiler: it's better to have more than enough healthcare than too little, but because insurance companies are greedy, they make us opt for as little as possible.
Getting back to the follow-up visit. In rare instances, when the child is doing extremely poorly, a combination of medication and therapy may be recommended rather than simply therapy. So, naturally, guess what doctors mainly did at these follow-up visits?
Did you read the title? Yep, it's pills. Just pills, sometimes pills with therapy. Failure 2: throwing pills at it does not inherently fix anything. And, in quick succession, Failure 3: the pills prescribed tended to be the kind that were less likely to work, and with harsher side effects.
What's going on here? Well, it's likely a number of things.
An ounce of prevention is worth a pound of cure, but only if your priority is actually health. A lifetime prescription to an anti-depressant is much more reliable income than 4 years of therapy. Or a year of neurofeedback or TMS. The US system revolves around treating symptoms, not solving problems.
This is a systemic thing, not any one person's fault, but we ourselves play into it. Ads for this miracle drug or that pill are shown on TV, and people can decide they'll only get better if they have it. So people can go in for an appointment like this, and demand pills, and the doctor may see no apparent choice but to do as asked. I don't have statistics for how often this happens, but it's much easier to pretend a pill will solve your mental health problems than do the work of processing traumas. (It doesn't work like that, but shhh, we're treating symptoms over here!)
However, there is one major piece aside from this that you can look into yourself. Your doctor is legally allowed (for some reason) to take money and gifts from private companies. Those gifts are on record, and you can find them here on ProPublica. Look up your doctor(s). If they've taken money, look into why. Corrupt doctors absolutely exist, and do not have your best interests at heart. Choose a doctor that won't sacrifice your health to make their checkbooks fatter.
If I had to guess, it's this latter problem that explains why it was just pills prescribed, and often the wrong pills at that. I strongly suggest you take advantage of ProPublica's work, and avoid doctors with priorities other than your health.
Regardless of the why, the results will be disastrous for these 200k children. Untreated or mismanaged mental illness has lifelong effects. They deserve better. We all do.
(Pst! If you like seeing the latest autism-relevant research, visit my Twitter, which has links and brief comments on studies that were interesting, but didn't get a whole Reading the Research article about them.)
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