Understanding Big Barriers in Access to Mental Health Care
There is a mental health crisis in the US—the number of people needing mental health support has sky-rocketed and access to mental health care is insufficient to ensure help for everyone. 56% of people are trying to seek mental health care for themselves or a loved one, and 76% of Americans believe mental health is as important as physical health.1
The pandemic further fueled already rising numbers of depression and anxiety along with a host of other mental health issues. The rate of mental health disturbances among adults increased fourfold since 2019.2 For younger adults ages 18 to 24, the increase is even higher.3 Since the pandemic and this dramatic increase, it has been especially challenging for people who had already been suffering from mental illness and substance abuse to get the help they need because of barriers to mental health care and the proportional shrinking of resources.4
So, if it’s that important and needed… why are we facing such considerable access to care issues?
Although there are many considerations within access to care and barriers to care, within this analysis of access to care, we’re specifically looking at three large and interconnected barriers to accessing mental health care: geographic accessibility, financial accessibility, and provider accessibility.
Geographic and financial accessibility
Geographic access to care barriers are barriers based on where a person lives. Mental healthcare shortages are greatest in rural and low-income urban areas. 75% of the US is comprised of rural land, and 62 million people live in rural areas. Around 20% of these rural residents struggle with mental illness, substance dependence, and mental health complications from chronic conditions.5 Yet 65% of non-metropolitan counties do not have a psychiatrist, and 47% of non-metropolitan counties do not have a psychologist. Many rural residents must travel long distances to receive services, and they are less likely to be insured for mental health services. This means that mental health care in rural communities is often regarded as a last resort instead of a preventative measure or an ongoing program of wellbeing. Frequently, the problem is only treated when it becomes a full-blown crisis and that can have devastating consequences.6
Urban areas face their own geographical barriers to mental health access. Overpopulation and crowding are obstacles for underserved urban dwellers seeking mental health treatment. Highly populated areas frequently see crowded emergency rooms and mental health community treatment centers.7 Urban areas have a reputation for greater access to services and resources. However, disadvantaged individuals still struggle to obtain care due to financial, employment, and transportation limitations. Additionally, there is a disproportionate availability of mental health resources in higher income urban neighborhoods. Geographical maldistribution of providers in urban areas is widespread.8
Although they are densely populated, lower income urban areas are underserved in terms of access to non-emergency proactive mental health care. The lowest-income communities are less likely to have office based mental health practices with either physicians or nonphysicians.9 Living in low-income urban areas elevates risk factors associated with mental illness. These include poverty, homelessness, physical and mental disabilities, drug and alcohol abuse, and social isolation. All these factors have increased since the onset of COVID-19.10
Mental health provider shortages
The lack of mental health professionals is by far the largest barrier we’re currently facing for access to mental health care. Although the pandemic has exacerbated mental health issues for many—even pre-pandemic, there were not enough mental health care professionals.11
Mental health shortages range in severity across the country. 89.3 million Americans live in areas that are federally designated as Mental Health Professional Shortage Areas (MHPSA). 37% of the U.S. population are severely impacted due to shortages of mental health professionals including psychiatrists, nurses, clinical social workers, therapists, etc.11
The rise in demand is not just in the MHPSAs. According to a November American Psychological Association poll, 74% of providers polled nationwide said they were seeing more patients with anxiety disorders, and 60% said they were seeing more patients with depressive disorders. Nearly 30% said they were seeing more patients overall. Unfortunately, a greater number say they cannot keep up with the demand for their mental health services and must turn patients away who are desperate for support.12
Even in states like New Jersey and Massachusetts, who are purported to have the lowest proportions of mental health care shortages nationwide, the system for finding these providers is opaque. Large numbers of those seeking treatment are reporting long waiting lists, having to make multiple calls to find providers, being turned away by providers, and having a hard time finding affordable options.13
Several factors are contributing to the mental health provider shortage:13
- Higher average age – late 50’s for psychologists and late 60’s for psychiatrists. Many are reaching retirement age.
- Too few younger graduates to replace them largely due to salary. The field of mental health is not lucrative. Mental health counselors earn about $40,000 a year.
- Despite extensive education and professional training, Modern Health’s Physician survey ranked psychiatrist pay as the fourth lowest among medical specialties.
- Low reimbursement rates by government and commercial payers.
Where do we go from here?
Digital mental health apps represent a unique opportunity to expand the availability and quality of mental health treatment. Mental health apps have potential for improving the monitoring and management of mental health symptoms or disorders. The US National Institute of Mental Health (NIMH) has indicated that digital mental health tools provide cost-effective and scalable solutions to address the mental health treatment gap.14, 15
According to Blue Cross Blue Shield of Massachusetts (BCBSMA), more than 1,000 of their members are using digital mental health tools each month. 60% are new to therapy. Of the 30% that are using digital mental health tools for depression or stress report an average improvement of 30%.16
To save lives, families, and improve mental health in the workplace, Uprise Health has reimagined our mental health system and has solutions to improve individuals’ ability to find the care they need, when they need it, and delivered on their terms. Uprise Health’s services help workers remain healthy and productive—and out of the emergency department. Many people also see improvements in chronic medical conditions when their mental health improves. These results can save employers hundreds of thousands of dollars. The Uprise Health approach starts with involving employers, using technology to expand access to care, and reducing costs by fully coordinating mental and physical care.
If you’re looking for more information about how Uprise Health can help improve access to care, read how our access to care is addressed with Care Navigation in our digital EAP and mental health platform.