Solving the mental health access problem

Two new reports shine a light on how big the problems are and solutions on how to fix them

In a world where physical ailments are met with urgency and readily available medical treatments, the struggle for mental health access remains an infuriating paradox. The barriers to entry are formidable, with daunting obstacles lurking at every turn. Seeking mental health support can feel like navigating an endless maze of bureaucratic red tape, exorbitant costs, and limited resources. The demand is overwhelming, yet the supply is tragically insufficient. It is a harrowing reminder that our society's prioritization of mental health falls dismally short.

Families everywhere are left grappling with a system that fails to recognize the urgency and gravity of mental health challenges, leaving countless stranded in the depths of their suffering, desperately yearning for help. The battle for mental health access is an indignant battle against a fragmented system that is designed to give us exactly what we are getting. That design is dangerously good at making access difficult, and over decades, policy and payment models have only strengthened this design. Daily, we leave vulnerable souls to fend for themselves in a world that should be offering compassion and support and seamless, affordable, and comprehensive access to care.

What is access, and how should we consider changing our programs and policies to better make it possible to get what they need, where they need it? One of the challenges with measuring access is that there are different definitions or accepted standards for how to measure it, e.g., wait times vs. office visits. In addition, there are also differing opinions on “need,” therefore complicating who should be getting access to what, when, and why. Without consistency in what we expect and how we measure it, most default to the basics, which can be problematic and only further sustain the status quo, which is not working for most people.

As early as 1975, the National Institute of Mental Health (NIMH) required that all federally funded Community Mental Health Centers (CMHC) evaluate their programs in terms of accessibility of services. It’s not a new concept to measure access yet despite it being a word we use daily; we hear story after story of people not being able to access care.

This is where policy makers come in. There’s a role to play in redesigning the system to acknowledge the deficiencies while working to increase what matters most to people – quality and affordable care that can be accessed in a reasonable time.

Yesterday, Inseparable put out a new report looking specifically at access, what a significant problem it is, and what we can do about it. I am going to get into the report in just a second, but first, let me talk about a companion report, also initiated by Inseparable, driven by the wonderful actuarial team at Milliman.

The Milliman report looked at data state by state utilizing various data sources including surveys and proprietary claims datasets. In the report, Milliman highlights three pivotal dimensions related to access: prevalence of conditions, treatment patterns, and availability/affordability of providers. These up to date data, reinforce previous findings and again highlight pretty significant disparities based on where you live.

A few highlights:

• Access Disparities: Access to mental health services is highly variable across states and health care coverage types, leading to uneven accessibility based on geographical location, coverage type, needs, and personal resources.

• Usage and Treatment Gaps: While over 24 percent of individuals across major coverage types were diagnosed with a mental health condition, only 33 percent received treatment from a specialist. This highlights a significant gap in care based upon your health insurance, with Medicaid users exhibiting the highest treatment rates.

• Emergency Visits and Outpatient Therapy: Approximately 8 percent of emergency department visits included a mental health diagnosis, with Medicaid users having the highest rate of visits. Interestingly, the average number of therapy visits remained relatively consistent across different coverage types.

• Provider Shortages: Mental health provider shortages persist in every state, affecting over half of the U.S. population living in areas designated as Mental Health Professional Shortage Areas (HPSA). Psychiatrist shortages are prevalent nationwide, with only 27.7 percent of the needed psychiatrists available.

• Affordability and Coverage: Psychiatrists exhibit lower acceptance rates for health care coverage compared to other specialties. Out-of-pocket costs for psychotherapy visits averaged $174 for those without insurance coverage, posing some pretty steep financial barriers for some families. Additionally, a significant portion (16.4 percent) of commercial health insurance costs for mental health services were for out-of-network care.

  

  An example of data from the Milliman report. Visualizing the diagnosed prevalence of mental health conditions across states and markets. States are sorted by the blended prevalence rate, reflecting diagnoses across various health care coverage types.

In essence, the report underscored critical areas for intervention to enhance mental health care access and quality across the nation. Building off the Milliman report, Inseparable’s report turned to concrete policy recommendations for what state policy makers could do. Below are the three main areas highlighted in the Inseparable policy document titled, Improving Mental Health Care: The Access Report.

I could spend a long time talking about each of these areas as they all combine to make up policies that could be pursued to help improve access. While each one helps, the more policies you adopt, the more and more you work towards making access an easier thing to grasp for most people. These are built off the science of what we know works, and are tangible steps forward for states looking to do more for mental health.

What’s truly exceptional about the Inseparable report is that it shows where states are with all these policies. You can see a breakdown below to give you a idea.

In addition, each state has an overview of its population, including important data like who is covered, mortality data, and how many people are not receiving care.

Curious about your state? You can get a snapshot by clicking on the map found here on the website. Use these data and this report to advocate for better mental health access in your community.

I’d encourage you to take a look at the reports, and if you want to share with your friends who may not be as in the weeds as you on the topic, National Public Radio’s wonderful health reporter, Rhitu Chatterjee, wrote up a very accessible piece here highlighting both reports.

Not being able to access mental health care is a problem that’s taken too long to solve. I think of it like a heavily locked door. There’s a way in but you have to have a key. The right key. And you have to have it on you at all times. Well, policy makers hold these keys and can help lead a seismic shift in our health care landscape. They can help create a new paradigm where mental health takes center stage alongside medical care, and where access is possible no matter where you live or what coverage you may have. By redesigning the system to ensure better access to mental health, policy makers can unlock this problem that plagues all of us - getting timely help when we need it.