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Mental Health in America - Access to Care Data
Access to Care Ranking
The Access Ranking indicates how much access to mental health care exists within a state. The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability. A high Access Ranking indicates that a state provides relatively more access to insurance and mental health treatment.
The 9 measures that make up the Access Ranking include:
- Adults with AMI who Did Not Receive Treatment
- Adults with AMI Reporting Unmet Need
- Adults with AMI who are Uninsured
- Adults with Disability who Could Not See a Doctor Due to Costs
- Youth with MDE who Did Not Receive Mental Health Services
- Youth with Severe MDE who Received Some Consistent Treatment
- Children with Private Insurance that Did Not Cover Mental or Emotional Problems
- Students Identified with Emotional Disturbance for an Individualized Education Program
- Mental Health Workforce Availability
Access to Care Map
Adults with AMI who are Uninsured
12.2% (over 5.3 million) of adults with a mental illness remain uninsured.
Under the Affordable Care Act (ACA), the US continues to see a decline in Americans who are uninsured. There was a 2.5% reduction from last year’s dataset.
46 states saw a reduction in Adults with AMI who are uninsured. The largest reductions were seen in South Carolina (7.1%), Missouri (6.3%), Arkansas (6.7%), Arizona (5.6%).
The state prevalence of uninsured adults with mental illness ranges from 2.2% in Massachusetts to 23.0% in Texas.
Adults with AMI who Did Not Receive Treatment
56.4% of adults with a mental illness received no treatment. Lack of access to treatment is slowly improving.
Over 24 million individuals experiencing a mental health illness are going untreated.
The state prevalence of untreated adults with mental illness ranges from 41.5% in Maine to 67.5% in Hawaii.
Adults with AMI Reporting Unmet Need
One out of five (20.6%) adults with a mental illness reported that they were not able to receive the treatment they needed. This number has not declined since 2011.
Individuals seeking treatment but still not receiving needed services face the same barriers that contribute to the number of individuals not receiving treatment:
- No insurance or limited coverage of services
- Shortfall in psychiatrists, and an overall undersized mental health workforce.
- Lack of available treatment types (inpatient treatment, individual therapy, intensive community services).
- Disconnect between primary care systems and behavioral health systems.
- Insufficient finances to cover costs – including, copays, uncovered treatment types, or when providers do not take insurance.
The state prevalence of adults with AMI reporting unmet treatment needs ranges from 15.8% in Hawaii to 26.3% in the District of Columbia.
Adults with Disability Who Could Not See a Doctor Due to Costs
21.62% of adults with a disability were not able to see a doctor due to costs. An estimated 47% of adults are not receiving treatment because of costs.
According to the US Census Bureau (2010) 56.7 million individuals had a level of disability, with more than half reporting that their disability was severe.
Of adults (15-64) who were uninsured, 21% had a severe disability.
A review of literature on the barriers to healthcare faced by individuals with disabilities found that having no insurance, a lack of insurance coverage, and no usual source of care were the most common barriers.
The prevalence of adults with disability who couldn’t see a MD due to cost ranges from 12.45% in Hawaii to 30.91% in Mississippi.
Youth with MDE who Did Not Receive Mental Health Services
61.5% of youth with major depression do not receive any mental health treatment.
Youth experiencing MDE continue to go untreated. Among the top ranked states almost 50% of youth are not receiving the mental health services they need.
The state prevalence of untreated youth with depression ranges from 45.8% in Connecticut to 71.3% in Texas.
Youth with Severe MDE who Received Some Consistent Treatment
Nationally, only 25.1% of youth with severe depression receive some consistent treatment (7-25+ visits in a year).
Late recognition in primary care settings and limited coverage of mental health services often prevent youth from receiving timely and effective treatment.
The state prevalence of youth with severe depression who received some outpatient treatment ranges from 39.7% in Minnesota to 12.2% in South Carolina.
High percentages are associated with positive outcomes
and low percentages are associated with poorer outcomes.
Children with Private Insurance that Did Not Cover Mental or Emotional Problems
Despite the enactment of the Mental Health Parity and Addiction Equity law (MHPAE), private insurances have found subtle ways to limit coverage of mental health services. Insurance arbitrarily define what services are “medically necessary” and should receive coverage. A survey conducted by the National Alliance of Mental Illness showed that 29% of respondents reported that they or a family member were denied treatment because they were not deemed medically necessary. Additionally, the MHPAE did not remove limitations on patient visits and number of co-payments imposed by insurers.
Finally, contributing to lack of coverage is the severed relationship between mental health providers and insurers. Many health providers refuse to accept insurances primarily because insurers continue to underpay them for their services. As a result, insured individuals are left with two options: costly, out-of-network services or no treatment.
The state prevalence of children lacking mental health coverage ranges from 3.2% in Massachusetts to 21.9% in Mississippi.
Students Identified with Emotional Disturbance for an Individualized Education Program
Only .763%* of students are identified as having an ED for IEP.For purposes of an IEP, the term “Emotional Disturbance” is used to define youth with a mental illness that is affecting their ability to succeed in school.
Early identification for IEPs is critical. IEPs provide the services and support students with ED need to receive a quality education. Inadequate education leads to poor outcomes such as low academic achievement, social isolation, unemployment, and involvement in the juvenile system.
The rate for this measure is shown as a rate per 1,000 students.The calculation was made this way for ease of reading.Unfortunately, doing so hides the fact that the percentages are significantly lower. If states were doing a better job of identifying whether youth had emotional difficulties that could be better supported through an IEP – the rates would be closer to 8% instead of .8 percent.
The state rate of students identified as having an Emotional Disturbance (ED) for an IEP ranges from 27.72 per 1,000 students in Vermont to 1.97 per 1,000 students in Alabama.
High percentages are associated with positive outcomes
and low percentages are associated with poorer outcomes
Mental Health Workforce Availability
The term “mental health provider” includes: psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and advanced practice nurses specializing in mental health care.
A shortage in mental health providers has resulted in many individuals not accessing care and/or relying on emergency services for psychiatric care. The National Council for Behavioral Health reported during a recent three year period there was a 42% increase in the use of these emergency services.
Integrating primary care and behavioral health services is key for early identification and intervention, but is only part of the solution. Primary care providers cannot fill the void created by a lack of psychiatrists. More than 50% of psychiatrists are expected to reach retirement by 2025, and the number of physicians willing to enter psychiatry continues to decline. This is primarily due to inadequate reimbursement by payers, pushing psychiatrists into private practices that do not accept insurance.
The state rate of mental health workforce ranges from 180:1 in Massachusetts to 1,180:1 in Alabama.