There is very little equity between physical healthcare and mental healthcare. That isn’t supposed to be the case, but it clearly is. Here we explore the issues surrounding the access to mental healthcare.
Behavioral/mental health issues are rampant in our society, but they are not addressed as much as we would like. An estimated 26% of Americans over 18 years of age suffer from a diagnosable mental disorder in a given year, and many suffer from more than one mental disorder.
MENTAL HEALTH SHOULD BE ACCESSIBLE
To ensure equitable access to mental health care, Congress passed the Mental Health Parity and Addiction Equity (MHPAE) Act in 2008 that requires health insurers and group health plans to provide the same benefits to enrollees for mental health/substance use disorder (MH/SUD) care as medical/surgical care. The key points covered by the Act include:
- An individual health plan or a group health plan that provides medical/surgical benefits and MH/SUD benefits should have the same financial requirements (co-payments, deductibles, etc.) and treatment limitations (such as number of visits or days of coverage) for both types of services
Find what different health insurance terms mean here.
- MS/SUD benefits should not have any separate cost-sharing requirements or treatment limitations
- If an individual or group-health plan includes out-of-network (OON) benefits for medical/surgical treatment, similar benefits should be provided for MH/SUD care
- There should be transparency around standards used by the insurance plan for determining medical necessity of treatment or when benefits are denied to a patient
COMMON BARRIERS IN ACCESS TO MENTAL HEALTH
However, access to mental health care does not come easy and is riddled with barriers at various levels. An online survey of 5,000 American adults found that despite a high demand for mental health services, there is a basic problem with lack of access to care.
- High out-of-pocket cost and insufficient insurance coverage, including high rates of denials by insurers
- 42% percent identified cost and poor insurance coverage as the top barriers
- 17% said their insurance policy forced them to pick between care for their mental health condition and their physical condition
- Difficulty accessing psychiatric medications
- Limited options and long wait times
- 96 million Americans (38%) have had to wait longer than one week for mental health treatments
- 46% Americans have had to or know someone who has had to drive more than an hour roundtrip to seek treatment
- Social stigma
- 31% of Americans have worried about being judged over seeking mental health services
- Younger Americans are more worried about others judging them about seeking mental health services (49% Gen Z vs. 20% Boomers)
- State-level funding, geographic location, and income
- States are struggling with lack of funding for mental health care
- Rural location and low-income can prevent access to mental health care
Here’s how state’s rank in access to mental health care services: https://www.mhanational.org/issues/mental-health-america-access-care-data.
INSURANCE AND ACCESS TO MENTAL HEALTH
An online survey conducted by the National Alliance on Mental Illness (NAMI) among nearly 3,200 individuals with either private or public health insurance (Medicare/Medicaid) found that:
- 28% used an OON psychotherapy provider vs. only 7% used an OON medical specialist and 3% used an OON primary care provider
- The most common barriers to finding a provider were either the provider was not accepting new patients or would not accept the person’s health plan.
- Among those with private insurance, 34% had difficulty finding a mental health therapist who would accept their health insurance, in both urban and rural regions.
- Low reimbursement may prevent a health care provider from participating in a health plan’s network.
- OOP costs such as co-pays were higher for mental health serviced than for other types of medical care
Your health plan may be in violation of parity requirements if:
- There are higher costs or fewer visits for mental health services compared to other medical services
- You have to call to get coverage for mental health care services
- If the plan is not transparent about why it denied a mental health care service
- You cannot find an in-network mental health care provider that accepts new patients
SILVER LINING AND POLICY SOLUTIONS
- Between private and public insurance, Medicaid might provide the most comprehensive, well-researched, and clinically proven interventions, according to the NAMI survey
- Medicaid patients were also more likely have access to in-network mental health services compared to those with private insurance
- However, this may not hold true in states where Medicaid mental health services are run by managed care organizations
- More than 66% of Medicaid enrollees reported no OOP costs for mental health services
How can this situation be resolved? NAMI makes several recommendations to remove some of the existing barriers to access:
- Regulators at the state and federal level should audit private health insurance plans and Medicaid managed care organizations to make sure they comply with the MHPAEA with respect to:
- Adequate reimbursement for mental health service providers
- Appropriate benefits for enrollees, including access to a broader mental health service provider network so they do not have to go OON
- Increase access to tele-mental health services
- Promote prescription of mental health medications by advanced nurse practitioners and other appropriately trained health care professionals
- Mental illness: definitions and statistics. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml.
- State ranking in access to mental health care services: https://www.mhanational.org/issues/mental-health-america-access-care-data.
- Fact sheet on mental health parity: https://www.nami.org/NAMI/media/NAMI-Media/downloads/Parity-infographic.pdf.
Patients Rising University acknowledges the important contributions of Surabhi Dangi-Garimella Ph.D. in this article. Improving patient access is our mission and we’re happy to utilize a variety of experts to carry that out.
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