New Report Shows Burden of Major Depressive Disorder, Access to Care a Significant Problem

Alexandria, VA—A new analysis by Avalere and Mental Health America (MHA) finds that significant barriers to quality care for individuals with Major Depressive Disorder (MDD) exist, that insurance coverage does not necessarily equal access to care, and that patients often feel left out of their own treatment. This infographic summarizes the results found in the white paper.

About 16 million American adults have MDD.  MDD can often cause cognitive difficulties (lack of concentration, ability to focus, stay on task, etc.), lack of energy, and sleep issues that affect people’s ability to manage day-to-day activities.  Avalere and MHA developed this report to describe the current state of quality of care for individuals with MDD and provide an evidence-based assessment of challenges and opportunities for quality improvement. 

Nearly 44 million American adults suffer from a mental illness in a given year. Of the population with MDD, only 35 percent are treated within the first year of developing symptoms; for others it can take 4 years or more. Many people don’t seek treatment in the early stages of mental illnesses because of discrimination, stigma, and lack of awareness of warning signs. Because of this, many mental health conditions aren’t addressed in a timely manner.

“Too many Americans are suffering, and far too many are not receiving the services they need to live healthy and productive lives,” said Paul Gionfriddo, president and CEO, Mental Health America. “This report is yet another reminder that we must improve access to care and treatments, and we should put a premium on early identification and timely intervention for everyone with mental health concerns. It is time to create a system in which we can address mental illness before a crisis occurs—Before Stage 4—and promote individuals’ recovery.”

The authors of the report conducted a structured literature review and key informant interviews to identify barriers to high-quality care and proposed solutions.

Some specific barriers identified include:

• Limited access by individuals to qualified mental health providers;
• Lack of specialized training for primary care providers in mental health;
• Limited reimbursement for non-physician healthcare professionals, such as nurse practitioners and physician assistants;
• Stigma associated with mental illness;
• Lack of assessment and monitoring tools and quality measures that evaluate outcomes that matter to patients (e.g. psychosocial factors, daily functioning, residual symptoms such as cognitive dysfunction); and
• Low levels of awareness among individuals and families of available support services and online self-management tools.

“We have known for a long time that delayed treatment is denied treatment,” continued Gionfriddo. “Furthermore, just because you have health insurance doesn’t mean you have access to care. About 4 million people with serious mental illness lack access to mental health services, despite insurance coverage under the Affordable Care Act—which is costing the United States $210.5 billion dollars a year. “

Avalere and MHA also identified a number of tactics to address challenges in MDD care. Successful implementation of these tactics will require collaboration among multiple stakehold­ers across the healthcare system, and include:

• Increase public awareness of depression through education and screening;
• Implement alternate models of care such as telemedicine to address gaps in timely access to care; 
• Encourage adoption of new payment and delivery models such as the Collaborative Care Model that facilitate more holistic care by specialists, case managers, and peer support specialists;
• Improve patient engagement and self-management through the effective use of shared decision making and patient education about MDD and available treatment options.                                                                                                          

“Depression can be an isolating illness and there is much work to be done in our mental health system,” concluded Theresa Nguyen, Senior Director of Policy and Programming, MHA. “But as this research shows, there are steps we can take to improve the lives of individuals dealing with MDD. If we act on these recommendations, we can help people get the care they need—before Stage 4.”

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Mental Health America is the nation’s leading community-based nonprofit dedicated to helping all Americans achieve wellness by living mentally healthier lives. Our work is driven by our commitment to promote mental health as a critical part of overall wellness, including prevention for all, early identification and intervention for those at risk, integrated health, behavioral health and other services for those who need them, and recovery as a goal.

Thank you to the Takeda/Lundbeck Alliance who provided funding for this research.