Which countries do healthcare (preferably socialized med) *and* mental health care well?

[WildflowerMom]

That's it.   Any countries that seem to have a lock on both?    TIA! 

[Melissa Louise]

Not us (AU)

The socialized medicine bit worked OK till the pandemic, although we do also have a private system alongside, but mental health is the poor relative and almost no-one can get adequate health care here without a stack of $ and even then, some luck.

If my GP agrees to it, I can get 10 subsidized sessions a year with a psychologist. Cost per session is $200, rebate is around $80. Better than nothing, but as I said in another thread, I work a second job to afford my mental health care. People who are unemployed or very low income have no chance of accessing even the ten sessions.

There is public mental health, and it's not great. My dd has used that system.

It keeps people alive, but not much more than that.

And if you're not in a major city, you are out of luck.

 

[lewelma]

Not us (NZ).

Mental health care is poorly funded here.

Edited January 24, 2023 by lewelma

[Melissa in Australia]

We have not found it to be such a huge problem.. Pre NDIS my twins were able to get the 10 sessions plus a further 5 a year, with only a $25 us pay rest paid by Medicare. 

Since they both qualify for NDIS because of their disabilities, we now have 15 hours + each a year fully funded. 

 

Because the boys are in out of home care I am eligible for 5 sessions with a psycologest that specialises in the difficulties working with children who are or have been foster kids. Self referral is all that is needed and it is by telihealth. I have never used it. 

When I was studying at uni the university offered free psycologest services. 

[Laura Corin]

Not the UK.

[Carrie12345]

On paper, maybe Finland?

I say maybe because isn’t Finland considered a pretty content country where the demand may not be as high as, say, the US? So it may not be a culturally equivalent issue.

Reading their social services policies is part of my assignment this week, lol.

[BeachGal]

7 minutes ago, Carrie12345 said:

On paper, maybe Finland?

I say maybe because isn’t Finland considered a pretty content country where the demand may not be as high as, say, the US? So it may not be a culturally equivalent issue.

Reading their social services policies is part of my assignment this week, lol.

I second Finland. Maybe some of the other Scandinavian countries, too.

[Carrie12345]

10 minutes ago, BeachGal said:

I second Finland. Maybe some of the other Scandinavian countries, too.

Also, because so many of their policies are preventative entitlements, I’d assume that plays a big part in reducing need-based programs.

[BlsdMama]

2 hours ago, BeachGal said:

I second Finland. Maybe some of the other Scandinavian countries, too.

I thought they had very high rates of suicide?

[EKS]

Do you mean socialized medicine or single payer?  Medicare covers mental health.

[Mrs Tiggywinkle Again]

1 minute ago, EKS said:

Do you mean socialized medicine or single payer?  Medicare covers mental health.

Trying to find a mental health practicioner that takes Medicare or Medicaid is nearly impossible where I live.  The county mental health agency is the only one that accepts either and there’s an eight month wait list.

[EKS]

2 minutes ago, Mrs Tiggywinkle Again said:

Trying to find a mental health practicioner that takes Medicare or Medicaid is nearly impossible where I live.  The county mental health agency is the only one that accepts either and there’s an eight month wait list.

This just means that they don't agree to the fee schedule and won't bill Medicare.  You can still submit the bill yourself and get reimbursed for what Medicare covers.  Of course that means that you're on the hook for the difference.

[BeachGal]

18 minutes ago, BlsdMama said:

I thought they had very high rates of suicide?

That’s true but they are willing to address mental illness so as to prevent suicides instead of sweeping it under the rug. Mental illness is less stigmatized there.

[Mrs Tiggywinkle Again]

Just now, EKS said:

This just means that they don't agree to the fee schedule and won't bill Medicare.  You can still submit the bill yourself and get reimbursed for what Medicare covers.  Of course that means that you're on the hook for the difference.

If it’s anything like the hospital or ambulance fee schedule, the reimbursement is well below the actual cost.  A private appointment at a good counseling place here is $200-250 an hour if you’re paying cash.  Medicare’s reimbursement is half that according to this chart.  Most of the people I know on Medicare are on fixed incomes and couldn’t afford to come up with the rest of that themselves.

https://www.apaservices.org/practice/medicare/medicare-news/2022-fee-schedule

[EKS]

4 minutes ago, Mrs Tiggywinkle Again said:

If it’s anything like the hospital or ambulance fee schedule, the reimbursement is well below the actual cost.  A private appointment at a good counseling place here is $200-250 an hour if you’re paying cash.  Medicare’s reimbursement is half that according to this chart.  Most of the people I know on Medicare are on fixed incomes and couldn’t afford to come up with the rest of that themselves.

https://www.apaservices.org/practice/medicare/medicare-news/2022-fee-schedule

Medicare reimbursement rates vary by area.  https://therathink.com/medicare-reimbursement-by-state/

 

[Calm37]

56 minutes ago, Mrs Tiggywinkle Again said:

If it’s anything like the hospital or ambulance fee schedule, the reimbursement is well below the actual cost.  A private appointment at a good counseling place here is $200-250 an hour if you’re paying cash.  Medicare’s reimbursement is half that according to this chart.  Most of the people I know on Medicare are on fixed incomes and couldn’t afford to come up with the rest of that themselves.

https://www.apaservices.org/practice/medicare/medicare-news/2022-fee-schedule

I have a Medicare Advantage plan, and it just requires a $35 copay.

[TechWife]

22 minutes ago, Calm37 said:

I have a Medicare Advantage plan, and it just requires a $35 copay.

Most psychiatrists won’t participate in any Medicare plans due to low fee schedules.

There are three parts to healthcare accessibility.
Right place - Are there the right types of providers in the physical locations where they are needed? Are the needed equipment and supplies available? Are there reliable supply chains? Appropriate transportation.? This is a demographic question that takes into account population density, the age and community health indicators of a given area as well as a logistical question that takes into account supply chains, transportation, geological features and weather patterns. 

Right time - Is the care available at the time of need, or are office hours accessible, providers taking new patients, short waits for appointments, crisis and emergency care available? 

Right price - Meaning is the cost of care affordable to patients at the point of service? Are there practitioners that have entered into contracts or accept Medicare or Medicaid fee schedules?

After accessibility is addressed, quality of care enters the picture, and that’s a piece of healthcare that is incredibly important and least ascertainable to patients & families. This is where standards of care and quality indicators come into play. 

Getting all the pieces together in one place is the challenge. 

[fraidycat]

I don't know who does have it, but I know it's not Canada.

[Innisfree]

1 hour ago, Calm37 said:

I have a Medicare Advantage plan, and it just requires a $35 copay.

The trouble is that access to this depends on having providers in the area who accept what Medicare pays them. It’s not about what you have to pay, it’s about what they feel they need to charge for their time. 

And, of course, not everyone has access to Medicare or Medicaid.

Plus all the issues others have mentioned, of course.

[Bootsie]

I don't know that a single country does everything in the medical arena well.  DH lived in Canada for five years and was pleased with the medical care that he received there, but knew Canadians who came to the US for specific types of care they could not receive in Canada within a reasonable time frame.  We have had reasons to use the Austrian medical system for a number of different reasons over the past 30 years and have been very pleased with the service, but I also know of cases where the service and care falls behind what can be received in the US.

In addition, I think there are great cultural differences that impact the types of medical care needed and provided in different countries.  Does a country have homeless Vietnam era vets on the streets in need of services, or is that not an issue for the country?  Does the country accept long-term involuntary hospitalization and medication for mental illness?  Does the country accept assisted suicide--is it counted as suicide, showing up in mental health issues or does the lack of the availability of assisted suicide count against a country's access to medical care?  

[JumpyTheFrog]

I have no experience in getting therapy of any kind, so take this suggestion with a grain of salt. Would someplace like Better Help that offers online therapy help? Their website make it sound like it costs about $60-90 per week.

[maize]

I honestly don't think any country in the world does mental health care well.

Partly that's because in many cases we still don't have very good treatment options, and those we have are often very person-hour intensive.

[EKS]

3 hours ago, TechWife said:

Most psychiatrists won’t participate in any Medicare plans due to low fee schedules.

You can still get reimbursed at the Medicare rate even if the provider doesn't deal with Medicare.  

[Melissa Louise]

2 hours ago, JumpyTheFrog said:

I have no experience in getting therapy of any kind, so take this suggestion with a grain of salt. Would someplace like Better Help that offers online therapy help? Their website make it sound like it costs about $60-90 per week.

There are major ethical and quality issues with these type of offerings.

It can be better than nothing, or it can be worse than nothing.

[Melissa Louise]

1 hour ago, maize said:

I honestly don't think any country in the world does mental health care well.

Partly that's because in many cases we still don't have very good treatment options, and those we have are often very person-hour intensive.

Yes.

And unfortunately, for serious mental ill-health, an online CBT course won't cut it.

 

[WildflowerMom]

I’m so disappointed to read the responses.   I am trying to see if I can find out more about Scandinavian countries, but on the whole, I’m sad more options aren’t listed.   

[bolt.]

Not Canada.

There is some mental healthcare available through hospitals. It's basically only for an absolute crisis (you show up at the emergency room and leave with a referral) or inpatient needs (you are a danger to yourself or others; you can't meet your own basic needs and have no personal connections to provide support with that).

A family doctor (what we have instead of GPs) can do a basic diagnosis of depression or anxiety, and prescribe the standard types of medication for uncomplicated cases. A family doc can also refer you to a psychiatrist for an assessment (and a prescription) if your needs are more complicated than basic mild depression/anxiety. Waits for that kind of specialist are not short, and the service (I've heard) is fairly basic, efficient, and perhaps impersonal. You can not see a psychiatrist without a referral.

Otherwise you would arrange your mental healthcare with a private provider. Many employer healthcare plans do reimburse for these visits, with various limits and percentages, so that's not unusual for people who have jobs "with benefits" -- but not everybody does.

[wathe]

I'll be contrary and suggest that medical mental health care in Canada is actually pretty good  -- at least in my part of the country. (I acknowledge that access to care is not the same everywhere, and that rural and remote communities are under-serviced).  Managing social determinants of health s more challenging.

Most medical mental health care is provided by primary care physicians (and sometimes NP's).  They are well trained and can competently manage most cases.  Funded by the state.  Out-of-pocket for PCP care is $0 - no co-pays, no deductibles, nothing.  The biggest benefit of primary care mental health delivery model is excellent accessibility.

Complex cases get referred to psychiatrists, who mostly use a consulting model:  assessment and recommendations back to the PCP.  Some complex cases will be followed by a psychiatrist long-term.  Funded by the state.  Out-of-pocket cost $0

Emergency assessments (generally in emergency departments) in mod-large hospitals are usually multidiscplinary.  Crisis intervention team (social work, mental health nurse) and ED MD both available 24/7/365.  Psychiatrist consultation at EDMD discretion.  Involuntary admissions are assessed by a psychiatrist.  All voluntary admits in my hospital are also seen by a psychiatrist.  Very small hospitals would tend to transfer care to a larger centre with a multidisc team.  Funded by the state, out-of-pocket cost 0$.  Cases that are not admitted are discharged to some sort of followup - multidisc crisis team, urgent outpt psychiatrist, community orgs or family doctor.  all of these are funded by the state, out-of-pocket cost $0.

Talk-therapy and other therapies with non-MD's is not as easily available, and generally not funded by the state.  This is generally where private insurance provided by employers comes in.

There are no private psychiatrists or family doctors in my province.  In my province, It is illegal for MD's to bill privately for services that are covered by the state, or to extra-bill (charge an extra fee beyond state funding) for these same services.  

We do not have universal pharmacare.  Pharmacare varies by province.  In by province, those under-25, over-65, those on state disability benefits and welfare benefits, and first nations people with status cards have meds paid for by the state. 

Part of judging how good a country delivers mental health care depends on how we define mental health and what we mean by mental health care --- western medicine cannot fix social determinants of health.  Homelessness, poverty, abuse, addiction, food insecurity... the list is endless.   Sometimes, when I hear people complain about access to mental health care, what they actually seem to be doing is medicalizing social issues --- seeking medical solutions to problems that are not solvable by western medicine.  Canada does pretty well with the medical aspects of mental health delivery.  Managing social determinants of health, on the other hand, not nearly as well as we should.

 

[maize]

34 minutes ago, wathe said:

 

Most medical mental health care is provided by primary care physicians (and sometimes NP's).  They are well trained and can competently manage most cases.  Funded by the state.  Out-of-pocket for PCP care is $0 - no co-pays, no deductibles, nothing.  The biggest benefit of primary care mental health delivery model is excellent accessibility.

 

Do people have access to treatments like TMS? If primary care providers are mostly just dispensing SSRI's and calling it good I'd see that as a major concern.

[TechWife]

4 hours ago, EKS said:

You can still get reimbursed at the Medicare rate even if the provider doesn't deal with Medicare.  

Yes, you have to file your own claim and you will get a small portion of your payment back. Right now in the area where I live psychiatric care is at least $200 per hour. Medicare pays roughly $34 per visit. Better than nothing, but no where near what the actual cost is.

[EKS]

40 minutes ago, TechWife said:

Yes, you have to file your own claim and you will get a small portion of your payment back. Right now in the area where I live psychiatric care is at least $200 per hour. Medicare pays roughly $34 per visit. Better than nothing, but no where near what the actual cost is.

I'll defer to your expertise here, since I have no direct experience.

[TechWife]

2 hours ago, wathe said:

 

…

Part of judging how good a country delivers mental health care depends on how we define mental health and what we mean by mental health care --- western medicine cannot fix social determinants of health.  Homelessness, poverty, abuse, addiction, food insecurity... the list is endless.   Sometimes, when I hear people complain about access to mental health care, what they actually seem to be doing is medicalizing social issues --- seeking medical solutions to problems that are not solvable by western medicine.  Canada does pretty well with the medical aspects of mental health delivery.  Managing social determinants of health, on the other hand, not nearly as well as we should.

 

Say it louder for the people in the back!

Here, failure to address social determinants often causes mental health problems. Mental health problems often cause homelessness as well.  We are really bad at criminalizing mental health care here. The first responder to a mental health crisis is a police officer, usually more than one. A host of behavioral issues can come under the banner of “disturbing the peace” and the police are called, for example.

It is usually  less expensive to take care of the social determinants than it is the resulting health issues. Lack of funds can lead to poor diet which can contribute to heart disease, diabetes and overall general health. That same lack of funds makes care hard to access. lack of funds makes medication unaffordable, so illnesses go untreated until they reach a crisis point. It’s really sad. 

[WildflowerMom]

@wathe, would you mind messaging me the area you’re in?    Just a general area would be appreciated.  Thank you!

[BlsdMama]

12 hours ago, BeachGal said:

That’s true but they are willing to address mental illness so as to prevent suicides instead of sweeping it under the rug. Mental illness is less stigmatized there.

I have to say something doesn't add up.
It's said Finland has the highest rate of happiness.
They've destigmatized mental illness.
Suicide prevention is happening.

1+1+1=3
If the answer to lower suicide is increased happiness, low mental health stigma, covered healthcare, and active suicide prevention they would HAVE lower suicide rates.  It doesn't track.  Or we don't yet adequately understand suicide.

I think no one does mental illness well because we don't really understand the mechanisms or spectrum of mental illness. 😞 

[KSera]

6 hours ago, Melissa Louise said:

It can be better than nothing, or it can be worse than nothing.

Yeah, I’d say the same goes for pretty much every mode of mental health care delivery. 

[wathe]

3 hours ago, maize said:

Do people have access to treatments like TMS? If primary care providers are mostly just dispensing SSRI's and calling it good I'd see that as a major concern.

PCP's here do not dispense.  They assess, diagnose, formulate treatment plans, manage, and prescribe.  Treatment plans often include meds, but not always.  Some PCP's do psychotherapy (state funded 100%).

TMS is not (yet!) covered by the provincial plan in my province, but is available through teaching hospitals (funded, ie UHN in Toronto.). Would require referral to a psychiatrist to access this way. In Canada, IIRC, it is approved only for treatment-resistant depression and OCD. It is covered in some other provinces.  I think that state funding for TMS in my province will happen in time, but we are not there yet.  (There are private TMS clinics, though, based on their websites, the ones I've seen seem very commercial/profit driven and shady to me.)

 

[BeachGal]

2 hours ago, BlsdMama said:

I have to say something doesn't add up.
It's said Finland has the highest rate of happiness.
They've destigmatized mental illness.
Suicide prevention is happening.

1+1+1=3
If the answer to lower suicide is increased happiness, low mental health stigma, covered healthcare, and active suicide prevention they would HAVE lower suicide rates.  It doesn't track.  Or we don't yet adequately understand suicide.

I think no one does mental illness well because we don't really understand the mechanisms or spectrum of mental illness. 😞 

Hmm. We must be looking at different data. The stats I’ve seen show Finland’s suicide rate has been falling slowly over the past 30 years or so with a few out of sync years.

I do think there has been some interesting research in specific areas of mental health recently but it can take many years, even decades, for something new to become more widely accepted and used.

This is a bit off tangent but one of the school districts we lived in runs a free program where new research/ideas are presented to interested parents, counselors and educators by the researchers/experts/authors  themselves. I found it enlightening at times. If anyone would like to check it out (free!), they do offer some of the taped lectures online which you can find by clicking on the three horizontal bars in the upper right corner.

https://www.familyactionnetwork.net/

[BeachGal]

Here is more information about Finland’s suicide rates. Young people there still struggle with mental health issues, though, and in response an updated suicide prevention program was created which is outlined in the link below.

https://borgenproject.org/mental-health-in-finland/

Mental health in Finland is not a new issue. The country dealt with dramatically high suicide rates in the 80s and 90s. This led to the creation of the National Suicide Prevention Project in 1986. The Project focused on preventing suicide by strengthening mental health services throughout the country, educating the media on reporting suicides and improving public conversation on mental health. The project was extremely successful as the country’s suicide rates decreased by 50% since 1990.

 

[ScoutTN]

15 hours ago, TechWife said:

Yes, you have to file your own claim and you will get a small portion of your payment back. Right now in the area where I live psychiatric care is at least $200 per hour. Medicare pays roughly $34 per visit. Better than nothing, but no where near what the actual cost is.

A routine psych office visit is over $300 here. (Medium sized city with 3 huge hospital systems, one of which is a big-deal teaching hospital.) Often not covered by medical insurance. Comes under “behavioral health” which is limited. Most others we know have similar coverage. 

Edited January 25, 2023 by ScoutTN

[BlsdMama]

1 hour ago, BeachGal said:

Here is more information about Finland’s suicide rates. Young people there still struggle with mental health issues, though, and in response an updated suicide prevention program was created which is outlined in the link below.

https://borgenproject.org/mental-health-in-finland/

Mental health in Finland is not a new issue. The country dealt with dramatically high suicide rates in the 80s and 90s. This led to the creation of the National Suicide Prevention Project in 1986. The Project focused on preventing suicide by strengthening mental health services throughout the country, educating the media on reporting suicides and improving public conversation on mental health. The project was extremely successful as the country’s suicide rates decreased by 50% since 1990.

 

Thank you for sharing that!

[Mrs Tiggywinkle Again]

15 hours ago, TechWife said:

Yes, you have to file your own claim and you will get a small portion of your payment back. Right now in the area where I live psychiatric care is at least $200 per hour. Medicare pays roughly $34 per visit. Better than nothing, but no where near what the actual cost is.

It’s the same here, which is why most people who have Medicare(and even Medicaid, though that seems to be a little bit easier) do not seek psychiatric or other mental health care.

It may vary in other places; this is just my experience.  The out of pocket cost was too much for my loved one on Medicare and a fixed income.

[TechWife]

33 minutes ago, Mrs Tiggywinkle Again said:

It’s the same here, which is why most people who have Medicare(and even Medicaid, though that seems to be a little bit easier) do not seek psychiatric or other mental health care.

It may vary in other places; this is just my experience.  The out of pocket cost was too much for my loved one on Medicare and a fixed income.

Yes, it's a Federal law, so it applies all over the US for those plans. Cost is a huge barrier to mental health care along with the availability of qualified providers.

[Pam in CT]

1 hour ago, TechWife said:

Yes, it's a Federal law, so it applies all over the US for those plans. Cost is a huge barrier to mental health care along with the availability of qualified providers.

cost and

availability and

stigma. 

 

Availability is worse in some geographic areas (generally lower population and lower income); the lack of/ insufficient coverage fuels a self-reinforcing perverse market pressure whereby mental health providers are severely financially discouraged from setting up practice in the regions that most need more providers.  Stigma is definitely an issue in virtually all regions / cultures / socioeconomics but is greater in some than others.

 

[rebcoola]

1 hour ago, Pam in CT said:

cost and

availability and

stigma. 

 

Availability is worse in some geographic areas (generally lower population and lower income); the lack of/ insufficient coverage fuels a self-reinforcing perverse market pressure whereby mental health providers are severely financially discouraged from setting up practice in the regions that most need more providers.  Stigma is definitely an issue in virtually all regions / cultures / socioeconomics but is greater in some than others.

 

Availability is huge we have no covered psychiatrists closer than 2.5 hrs away.  Thank goodness for virtual appointments.  

[wathe]

Psychiatrists are 100% state funded in my province, and cannot legally charge privately for services covered by the state.

Access to PCP mental health care and, with referral, psychiatrist care that is 100% funded care, with no out-of-pocket cost is a big deal.  

Canadians love to complain about their healthcare (and it's not perfect!), but 100% state funded primary and specialist care and hospital care is actually a very big deal that our nation tends to take for granted.  

Edited January 25, 2023 by wathe