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Before the trip to the Center for the Intrepid, Smith couldn’t look at his leg, which was shattered during a Nov. 18, 2018, game between his Washington team and the Houston Texans. A flesh-eating bacteria consumed his leg while he was in the hospital, almost killing him.
Although it was nearly three months after the injury, listening to peoples’ stories at the Center for the Intrepid started his recovery, Smith said.
“That’s the first time I did not feel alone and did not feel scared,” he said. “That’s where I got out of a dark place where I was consumed by my own self-doubt and pivoted to being an active participant in my recovery and confronting my injury. That physical recovery couldn’t have taken place if I hadn’t dealt with the mental side.”
Two years of rehabilitation, therapy and dozens of surgeries culminated in an NFL comeback with Washington. His play led the team to the playoffs for the 2020 season, and Smith won that year’s Comeback Player of the Year award.
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Physical and mental care often have been treated separately. More healthcare providers have been incorporating mental health treatment for patients who suffer traumatic injuries or diagnoses to aid their physical recovery. The COVID-19 pandemic has accelerated that shift as more people struggle with the trauma inflicted over the past two years.
Organizations like the Maryland-based Adventist HealthCare and Sunstone Therapies, a startup launched to treat both the physiological and psychological effects of cancer, are trying to establish a new treatment model by pairing the therapeutic hallucinogen psilocybin and psychotherapy to help cancer patients cope with their disease.
Adventists’ Aquilino Cancer Center screens each of its cancer patients for mental distress. It offers a psilocybin clinical trial that seeks to alleviate trauma and depression, meditation classes, one-on-one counseling, group therapy and community-based support services.
Insurers pay for some mental health therapy, but it’s typically a low amount. Agrawal said.
“There’s an underappreciation for the amount of stress cancer brings and how that impacts a patient’s life,” he said. “Reimbursement seems to be structured around medication and procedures rather than holistic care.”
People suffering from anxiety and depression are overwhelming emergency rooms. Child and adolescent mental health issues and suicide rates are surging.
Total mental health claims for children ages 13 to 18 doubled from mid-2019 to mid-2020, according to an analysis by FAIR Health.
More than 3 million adolescents and 12 million adults had serious thoughts of suicide in 2020, according to data from the National Alliance on Mental Illness. Close to 18 million adults experienced delays or cancellation of appointments and nearly 5 million went without necessary care, NAMI found.
“The feelings of isolation, the trauma from losing loved ones and the loss of structure and routine has created a perfect storm for mental health,” said Dr. Kamilah Jackson, a medical director at AmeriHealth Caritas, a Medicaid managed care provider. “We need to provide more funding and support to bring more mental health providers into the workforce.”
President Joe Biden proposed in his federal budget released last month spending $51.7 billion to improve the mental health system, including $7.5 billion for workforce development and service expansion and $35.4 billion to enhance mental health access for Medicaid enrollees. His budget would require health insurers to cover mental healthcare with adequate provider networks, which historically has been the bottleneck.
More than half of the counties in America don’t have a psychiatrist, said Kevin Mahoney, CEO of the University of Pennsylvania Health System, citing 2017 data from the American Medical Association.
“You may have an inpatient acute care hospital, but you don’t have the infrastructure to support it,” he said. “This is certainly among the top five issues America has to face.”
One day last week, 57% of the beds in Chester County Hospital’s emergency department in West Chester, Pennsylvania, were occupied by behavioral health patients, Mahoney said.
The academic health system has tried to mitigate mental health crises by incorporating related screenings and services into primary-care visits. It has embedded social workers into larger physician practices that connect patients with resources when they are discharged, set up virtual pathways for mental healthcare and started a joint venture with area providers. But as of now, the psychiatric care network is completely disjointed, Mahoney said.
“Long-term residential care has fallen apart, inpatient (psychiatric) beds for the most part have been ceded to the for-profit side and makes placement difficult,” Mahoney said.
Many people are taught to bury their feelings, especially in sports, Smith said. He hopes to set a different example as the public face of Teammates in Recovery, a mental health awareness campaign from DePuy Synthes, the orthopedics division of Johnson & Johnson.
Teammates in Recovery, which Smith is compensated to promote, seeks to create a community of support and resources for people who have experienced a traumatic injury.
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