The demand for behavioral healthcare services is more significant than ever, with approximately six out of ten Americans needing services either for themselves or someone they love. The Centers for Disease Control and Prevention (CDC) has stated that upwards of 50% of Americans will be diagnosed with a mental illness sometime in their life. It is also true that one out of every 25 people lives with a mental illness. Sadly, half of the adults diagnosed with mental health conditions receive no treatment, and many with the illness never get diagnosed. Yet, despite these evidence-based statistics, several significant barriers remain.
The top five barriers to behavioral healthcare access include:
- Financial resources
- Lack of mental healthcare services
- Fragmented care
- Fear of stigma
- Lack of education and awareness
Each of these items has a price on the access of people to behavioral and mental healthcare. Some of them have simple solutions and others are much more complex.
Financial resources are a common barrier to behavioral healthcare
Finances are the most common barrier to individuals in need of care for behavioral health issues, with over 42% of Americans citing cost and poor insurance coverage. As a result, many people are forced to choose between opting for mental health treatment and paying for daily necessities.
Though the Affordable Care Act requires medical insurers to provide behavioral and mental healthcare coverage, the high cost of treatment frequently limits access to care.
Lack of financial resources can prevent individuals from seeking help or result in inconsistent or inadequate treatment. In addition, insurance or other financial assistance is often insufficient to cover costs, which can add up quickly, especially when regular therapy, complicated medication treatment, or intensive treatment is required.
For mental health therapists, psychiatric providers, and specialty care, out-of-pocket expenses commonly exceed upwards of $200 versus primary care for outpatient services.
Fortunately, Congress is stepping up to the issue of behavioral healthcare access with two pieces of legislation regarding mental healthcare parity. (The National Alliance defines parity on Mental Illness as the equal treatment of mental health conditions and substance use disorders in insurance plans.) In addition, one bill could provide states with resources to step up enforcement against insurers for mental health parity issues.
Another would allow the Labor Department to impose monetary penalties on companies whose plans do not comply with parity laws. Both bills have bipartisan support and are expected to move forward soon.
Lack of mental healthcare services in both rural and urban areas
More than 112 million people in the United States live in areas where the lack of mental healthcare services is problematic, and research indicates that this trend is likely to continue through 2025. Even when providers are available, many continue to operate outside the health insurance system, making them out of network.
Part of the reason is that insurers typically pay licensed mental health professionals lower negotiated rates for their services compared to health professionals with similar backgrounds and experience. As a result, today, only approximately 56% of psychiatrists accept commercial insurance compared to 90% of non-mental health providers.
The lack of mental healthcare services means that individuals seeking mental health care are five times more likely to receive care from out-of-network providers than those seeking medical or surgical services.
Although the recent pandemic has increased the need for mental health care, the lack of services is not a new problem. Data collected in 2018 showed that only about one-quarter of the country’s mental health care provider needs were being met.
89.3 million Americans reside in federally designated Mental Health Professional Shortage Areas, while only 55.3 million live in similarly designated primary-care shortage areas. Unfortunately, these statistics also show that rural areas often have few or no mental healthcare services.
Even in urban areas, clinics and providers have long waitlists, leaving patients to suffer for months before they can get a basic intake appointment.
While the introduction of more telehealth services since the pandemic has helped somewhat, only 7% of Americans report using it for behavioral health issues. When asked whether they would use it, about 45% stated that they would be open to the idea. Many insurers, including Medicare and Medicaid, have expanded coverage to include telehealth options.
Fragmented care between mental health and physical health
In the U.S., approximately 51% of providers state that fragmented care between mental health and physical health is a significant barrier to adequate behavioral healthcare access. In addition, having care separated results in the suboptimal treatment of those with mental health disorders.
A report issued by the New England Journal of Medicine stated: “Clinicians should be able to easily access and share information about patients, enabling different specialties to work together to create comprehensive treatment plans.”
Technology is helping and is what Julota’s interoperability platform offers: bridging the gap between healthcare organizations using different EHR (electronic health record) systems and ePCR (electronic patient care reporting systems).
Sensitive healthcare information is kept safe through our secure cloud-based platform.
Fear of stigma by seeking mental health treatment
Numerous studies have shown that mental illnesses are subject to negative judgments and stigmatization more than any other type of illness. Unfortunately, in many cases, that fear of stigma prevents people from receiving treatment.
31% of Americans say they have been worried about others judging them once they knew they had sought mental health services. The stigma surrounding the mentally ill has existed for centuries: in ancient Greece, a “stigma” was a brand used to mark criminals or enslaved people.
During the Middle Ages, mental disorders were regarded as a punishment from God. The ultimate stigmatization reached its peak during the Nazi reign in Germany when hundreds of thousands of mentally ill people were murdered or sterilized.
Research into the impact of mental illness has come far in recent years but has only recently begun to examine the stigma regarding the illness more thoroughly. However, social scientists and psychologists agree that stigma exists in two areas: public stigma and self-stigma.
Public stigma is the general population’s reaction to those with a mental disorder. Self-stigma involves internalizing public stigma, which those with a mental illness turn against themselves.
Here in the Western world, stigmas about mental illness appear to be widely endorsed by the public. Sadly, these views are not limited to uninformed people; even mental health professionals sometimes subscribe to stereotypes.
Organizations like the National Alliance on Mental Illness (NAMI) strive to wipe out stigma through campaigns such as Pledge to be Stigma-Free and education on ways to fight mental health stigma. Everyone, not just those diagnosed with a mental health condition, can help fight stigma in their own lives and their communities.
Mental health stigma is more than an interpersonal issue: it is a health crisis. People with mental health disorders often die much sooner than they should, not because of increased injuries or suicide, but poor physical health.
Several factors contribute to this: side-effects of medications, combined with lifestyle factors such as lack of exercise, inadequate diet, and smoking, as well as inaccessible care, and even prejudice from practitioners. Appallingly, the physical health care that individuals with mental illness receive is often poor compared to what should be given. Stigma drives this inequality, but it also silences our outrage as a community.
Lack of education and awareness of mental health issues
Consider the following scenario: it’s Wednesday afternoon, and Joni walks her dog in the park. She’s feeling pretty good, enjoying the sun on her face and the quiet time. Next, we see Joni Wednesday night before bedtime, feeding her cats and thinking suicidal thoughts.
The average person cannot understand what that would be like. No matter how hard she tries to explain it, people do not understand. Some tell her she is crazy, others that she is making it up or exaggerating to get attention, and some tell her it’s a character flaw.
The lack of education and awareness obstructs societal awareness and discourages people from getting help.
Awareness of behavioral health issues can help people understand that mental illness is not a character flaw or an imagined malady but an illness like any other. In addition, raising awareness can change how society views and responds to this complex issue.
Awareness provides knowledge, and knowledge is power. Therefore, it is key to understanding mental health and helping people get the help they need.
Mental health awareness initiatives can help those suffering to understand the symptoms and learn how the disorders manifest. When individuals recognize signs, they can seek treatment before the condition worsens and prevent severe disruptions to their life.
They are also more likely to experience fewer complications, have a successful recovery, and even live longer. In addition, education and awareness help the public more readily identify people who may be struggling and help them receive the necessary treatment.
Public awareness reduces stigma and opens opportunities for appropriate community resources.
Highlighting the top 5 barriers to behavioral healthcare access can help organizations better understand these issues and open the door to improving that access. Though impediments like financial resources and lack of mental healthcare services will likely take years to remedy, other factors are already seeing improvement.
Organizations like NAMI and SAMHSA (Substance Abuse and Mental Health Services Administration) are making great strides against the stigma and providing education and awareness programs that benefit those who have mental illness and the public.
Technology like Julota’s interoperability platform has also become a key player in establishing collaboration between a patient’s care team. Especially in regards to mental health and substance abuse.
Through their dedicated software, all team members can easily access and share patient information safely and securely.