Leading mental health and employer groups come together around health system solutions for the nation’s ‘staggering public health challenge’ in mental health.

WASHINGTON – Patients reported stark access challenges in seeking mental health and substance use care and startling disparities between mental versus physical health services in a report released today by The Bowman Family Foundation.

The report, based on a survey of 2,794 patients conducted by NORC, is titled Equitable Access to Mental Health and Substance Use Care: An Urgent Need. The survey found:

• More than half of patients (57%) who sought mental health or substance use care were unable to access any care on at least one occasion between January 2019 and April 2022.
• Of patients in employer-sponsored health plans, 39% reported using at least one out-of-network provider for mental health or substance use outpatient care, compared to just 15% for physical health care.
• Of patients using out-of-network provider, 80% reported using out-of-network mental health or substance use providers “all of the time” versus only 6% for physical health care.
• Even among patients who successfully made an appointment with a new in-network mental health or substance use provider, 40% had to contact four or more providers.

Findings even more concerning for adolescents

Nearly 70% of adolescents who sought mental health or substance use care did not receive any care on at least one occasion, compared to less than 20% of those seeking physical health care. Primary care doctors provide care for most patients with mental health conditions and write most prescriptions for psychotropic medications. The survey findings underscore that this care is often insufficient with 98% of adolescents who received mental health care from primary care providers reporting a need for more help from mental health specialists. Numerous studies have shown that primary care practices that integrate mental health specialty services generate significantly improved patient outcomes, including for depression, anxiety, substance use, and suicide risk. These integration approaches are crucial for early detection given the deteriorating mental health of adolescents over the last decade and during the COVID-19 global pandemic.

“This report lays out in clear terms what so many Americans feel in day-to-day encounters with the health care system, even when they think they are covered by insurance, whether it’s Medicare, Medicaid, or Commercial,” said Henry Harbin, MD, senior author of the report. “We recognize that insurers are providing a relatively high level of in-network access to the full range of specialty medical and surgical care for physical health diseases such as cancer, heart disease, and diabetes, despite workforce shortages among some of these medical providers. Our goal is the same effective access and outcomes for mental health and substance use.”

Recommendations

The report, which includes findings from eight other studies of network access, the majority of which are from 2022 and 2023, calls on all stakeholders – payers, providers, regulators, and legislators – to expand enrollment of mental health and substance use providers in payer networks; to drive the adoption of proven methods of integrating effective mental health services within primary care physician and pediatrician offices; to ensure reimbursement for tele-behavioral health at the same level as reimbursement for in-person care; and to demand full compliance with the federal and state parity laws already on the books.

“This report shows what employers have known and struggled with for years; timely access to in-network mental health providers is difficult to achieve for several reasons,” said Mark Wilson, Chief Economist at the HR Policy Association. “While large employers have implemented some benefits strategies to address the shortage of providers, addressing other systemic industry issues will take a concerted effort by all stakeholders. HR Policy Association represents three-quarters of Fortune 500 employers, and we’re committed to improving mental health and substance use access despite these workforce challenges.”

Supporters of the report recommendations include:

American Health Policy Institute

American Foundation for Suicide Prevention - GA

Association for Behavioral and Cognitive Therapies

Eating Disorders Coalition for Research, Policy &

     Action

Florida Alliance for Healthcare Value

Georgia Mental Health Policy Partnership 

The Goodness Web

HR Policy Association 

The Jed Foundation

Kansas Business Group on Health

The Kennedy Forum

Legal Action Center 

MidAtlantic Business Group on Health

Mental Health America 

Mental Health Association of Maryland

NAMI, National Alliance on Mental Illness

NAMI-Minnesota 

National Alliance of Healthcare Purchaser Coalitions

National Association for Behavioral Healthcare 

National Association of Addiction Treatment

     Providers 

National Council for Mental Wellbeing 

Northeast Business Group on Health

Northwestern University, Center for Behavioral

     Intervention Technologies

One Mind PsyberGuide

Residential Eating Disorder Consortium 

Shatterproof

Sylvan C. Herman Foundation

Treatment Advocacy Center

The Bowman Family Foundation (“BFF”) is a private foundation qualifying as a 501(c)(3) nonprofit organization. The primary mission of BFF is to improve the lives of people with mental health and substance use conditions. BFF also provides funding to support the education and welfare of children. BFF is the Managing Member of the Mental Health Treatment and Research Institute LLC (“MHTARI”), a tax-exempt subsidiary of BFF which conducts most BFF activities regarding mental health and substance use conditions. The survey conducted by NORC and preparation of the report were funded by MHTARI. Learn more at www.thebowmanfamilyfoundation.org.