This author's father-in-law sadly suffered with mental illness in addition to in his later life, dementia. He refused to believe that he had a mental illness and thus refused treatment which led to many struggles in itself. Right before the COVID pandemic, he fell and broke his hip which led to him having to be placed in assisted living. His dementia worsened and he suffered from bipolar. The assisted living had a hard time treating him and he acted out violently. He ended up being kicked out of the one facility and we had to find another one that would take him. COVID hit during his stay at the second facility so in addition to his dementia and mental illness, he was now not allowed visitors. He declined rapidly after that, both physically and mentally. They had to give him Haldol regularly and other medications to try and control his violent tendencies. This second facility threatened to kick him out as well. The only thing that would calm him was visits from his family.He was never officially diagnosed with bipolar due to his refusal and then when the dementia became bad, physicians would not even try to diagnose him at that point.

Recently there was an expansion of Medicaid benefits under the Affordable Care Act which increased access to health care for low-income individuals. Medicaid is the largest payer for mental health services in the US, so this was expected to be a positive move (Breslau, et al, 2020). Insurance coverage has been a barrier for people with mental illnesses due to high-cost medications, office visits, and in some cases hospital stays. Other barriers that exist are with provider supply and with individuals, like my father-in-law, that don't believe they have a mental illness and need help. In a study done in 2020, it showed that the number of psychiatrists who accepted Medicaid had decreased since 2014 Breslau, et al, 2020). Even though the use of mental health care has increased since the implementation of the ACA, without more access to provider help and the acknowledgement of the disease by individuals, there are still many concerns with untreated people and how to care for them.

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