Access to Quality Mental Healthcare Is Elusive for Millions of Americans. Here’s Why.

words Al Woods

More than 40% of Americans reported symptoms of anxiety or depression during the first year of the COVID-19 pandemic, according to a study published in the journal Nature.

That’s a nearly fourfold increase from the pre-pandemic baseline. Clearly, Americans are experiencing unprecedented mental health challenges amid an unprecedented public health crisis.

Mental Healthcare

To make matters worse, many of the most vulnerable Americans lack the means to pay for care. According to data from Mental Health America, more than 10% of Americans with a diagnosed mental illness have no health insurance. This makes it far less likely that they’ll seek non-emergent treatment for mental health issues — increasing the strain on an already-overstretched medical safety net and worsening individual health outcomes for the affected patients.

This is just one of many challenges facing Americans with mental health needs. Access to high-quality behavioral health support is sorely lacking for large swathes of the population — millions upon millions of children, parents, grandparents, siblings.

To address this problem, we first need to understand it. So let’s examine why mental healthcare remains elusive for so many of us.

Unequal Geographic Distribution of Mental Healthcare Resources

Medical specialty providers tend to cluster in large population centers. Mental healthcare providers are no different. Residents of rural areas and small cities, and even many medium-sized cities outside major metropolitan areas, often have no choice but to make hours-long journeys to access outpatient behavioral healthcare. Some stay overnight, increasing further increasing the expense and time commitment.

Likewise, rural areas and smaller population centers tend to be underserved by inpatient behavioral healthcare providers. This creates a burden for patients and their families, who must travel long distances to visit them in person. A handful of providers like Oceans Healthcare are intentionally targeting communities underserved by mental healthcare resources, but the industry will need to adopt an “all hands on deck” posture to keep pace with the growing need in these areas. 

Mental Healthcare

Uneven Adoption of Behavioral Telehealth Services

Behavioral telehealth is a suitable solution for many patients who can’t travel long distances for outpatient appointments and don’t require inpatient care. It’s also useful for behavioral healthcare facility residents who need to access specialty care outside the community’s walls.

Unfortunately, adoption of behavioral telehealth has been uneven at best, even after the pandemic. More support is needed from state and federal policymakers and from private stakeholders to ensure every patient who needs behavioral telehealth has access to it in timely fashion and at reasonable cost.

Lack of Adequate Health Insurance Coverage

On matter of cost: Lack of adequate health insurance coverage is a major barrier to mental healthcare access for millions of vulnerable Americans. The often high out-of-pocket cost of care means that even relatively well-off patients face difficulty paying for the care they need.

This is another issue that’s best addressed by policymakers and private stakeholders working together. Patients seeking private health insurance coverage may need help to better understand their eligibility for premium subsidies, which reduce costs for lower and middle-income patients; patients on government-run insurance programs like Medicaid and Medicare may need help to understand how those programs enable quality mental healthcare at low out-of-pocket cost.

Inadequate Transportation Access and Service

Some of the most vulnerable behavioral health patients don’t own cars or aren’t able to safely drive themselves to appointments. Many of these folks live in areas poorly served by public transportation or “dial-a-ride” services and lack adequate privately run alternatives.

Where behavioral telehealth isn’t an option (or the best option), adequate transportation is a critical piece of the puzzle. The issue is bigger than healthcare, of course; all the more reason for state and local policymakers to address it.

Social Stigma Around Seeking Mental Health Treatment

Finally, the social stigma around seeking mental health treatment is real and pervasive. A plurality of Americans report deferring behavioral health treatment due to stigma (real or perceived) in their community. The full consequences of this hesitancy are incalculable and solutions are elusive, but it’s clear the mental health community and stakeholders outside the industry need to work harder, together, to address it.

It Takes a Village

These five issues add up to significant disparities in mental healthcare access and outcomes. Each builds upon the other: Inadequate transportation worsens the already unequal distribution of mental healthcare resources across the country, inadequate health insurance coverage further reduces the likelihood of seeking care for those struggling with the social stigma of doing so, and so on.

Fortunately, we can clearly identify solutions to these issues. They won’t be easy to achieve and progress won’t occur overnight. But we must do better — and we can.


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