Cohen Veterans Network (CVN) and National Council for Behavioral Health issued the America’s Mental Health 2018 report, a comprehensive study of access to mental health care, at the 2018 Cohen Veterans Care Summit in Washington D.C.
The study, which assesses Americans’ current access to and attitudes towards mental health services, revealed American mental health services are insufficient, and despite high demand, the root of the problem is lack of access – or the ability to find care.
The study offers a comprehensive analysis of the state of mental health care in the U.S. It is comprised of a two-pronged research project that includes an online survey of 5,000 American adults, and a robust analysis of third-party data measuring patients’ access to mental health services in terms of four pillars – providers, facilities, funding and perceived satisfaction among patients.
“There is a mental health crisis in America. My experience establishing mental health clinics across the country, coupled with this study, shows that more needs to be done to give Americans much needed access to mental health services,” said Cohen Veterans Network President and Chief Executive Officer Dr. Anthony Hassan. “If we want to save lives, save families and save futures we must reimagine our behavioral health system and take concrete steps to improving consumers’ ability to find the care they need, when they need it, and on their terms.”
Despite Strong Demand for Mental Health Services, Common Barriers Remain
The demand for mental health services is stronger than ever, with nearly six in 10 (56%) Americans seeking or wanting to seek mental health services either for themselves or for a loved one. These individuals are skewing younger and are more likely to be of lower income and have a military background. The large majority of Americans (76%) also believe mental health is just as important as physical health.
“This study confirmed what we hear from our members every day, that individuals and families continue to struggle to find the help they desperately need,” said Linda Rosenberg, President and CEO of National Council for Behavioral Health. “Mental health and addiction providers need adequate funding to hire skilled staff, employ evidence-based practices and adopt innovative technologies – all of which will help us meet demand.”
Despite this strong demand and growing societal awareness of the importance of mental health in the U.S., the study revealed that the overwhelming majority of Americans (74%) do not believe such services are accessible for everyone, and about half (47%) believe options are limited.
These beliefs are driven by several perceived barriers in Americans’ ability to seek mental health treatment, including:
High Cost and Insufficient Insurance Coverage: Forty-two percent of the population saw cost and poor insurance coverage as the top barriers for accessing mental health care. One in four (25%) Americans reported having to choose between getting mental health treatment and paying for daily necessities.
Several individuals blamed the U.S. government and insurers for not providing enough funding and support for access. Nearly one in five of Americans, or 17%, noted they have had to choose between getting treatment for a physical health condition and a mental health condition due to their insurance policy. The majority (64%) of Americans who have sought treatment believe the U.S. government needs to do more to improve mental health services.
Limited Options and Long Waits: Access to face-to-face services is a higher priority for Americans seeking mental health treatment than access to medication. Ninety-six million Americans, or 38%, have had to wait longer than one week for mental health treatments. And nearly half of Americans, or 46%, have had to or know someone who has had to drive more than an hour roundtrip to seek treatment.
While most Americans have heard of telehealth as an option for treating mental health issues, only 7% have reported using it. When asked if they would be open to using it, almost half, or 45%, of Americans who have not already tried telehealth services said they would be open to the idea of trying a service to address a current or future mental health need.
Lack of Awareness: While most Americans do try to seek out treatment, there also is a large portion of the population who have wanted to but did not seek treatment for themselves or loved ones (29%)– in part due to not knowing where to go if they needed this service. What’s more, fifty-three million American adults (21%) have wanted to see a professional but were unable to for reasons outside of their control.
Furthermore, younger Americans (i.e., Gen Z and Millennials) are less sure about resources for mental health services, compared to older generations. This younger generation was also more likely to find it too hard to figure out legitimate resources online. Instead, many turned to unreliable resources for information, including Facebook, YouTube and Twitter.
Social Stigma: Nearly one-third of Americans, or 31%, have worried about others judging them when they told them they have sought mental health services, and over a fifth of the population, or 21%, have even lied to avoid telling people they were seeking mental health services. This stigma is particularly true for younger Americans, who are more likely to have worried about others judging them when they say they have sought mental health services (i.e. 49% Gen Z vs. 40% Millennials vs. 30% Gen X vs. 20% Boomers).
Stark Disparities in Accessibility at State and Income Levels
Based on the analysis of third-party data, states are struggling to keep up with demand due to lack of funding and facilities, and, to a lesser extent, providers. Texas, Wisconsin and Georgia ranked among the lowest in terms of lacking adequate number of providers, facilities and funding to support the states’ populations. Pennsylvania, New York and Minnesota ranked among the top.
There is also a large disparity in access to mental health care based on level of income and location. Individuals located in rural areas and of lower-income are less likely to say that mental health services are extremely accessible to them.
Compared to middle- and high-income households, low-income Americans are less likely to know where to go for treatment and more likely to use a community center verses a qualified mental health center. Of the Americans that have not sought mental health treatment, more than half, or 53%, were in low-income households.
In addition, compared to Americans living in urban and suburban areas, individuals living in rural areas are less likely to proactively seek mental health specialists they need, and instead go to their primary care doctor or community center for treatment. Rural Americans are also less accepting of mental health services and care.
The Path Forward
We believe that more must be done to improve access to care for everyday Americans. Specifically, younger Americans need more information on how and where to access care. There must also be a better understanding of the real cost of delivering mental health care and related reimbursement rates, which typically cover only a small portion of care. This is critical to help attract new providers into the field and more must be done to train and retain providers to help ensure people can get help when they need it. Finally, we must ensure standards of care are consistent through continued adoption of evidence-based practices.
If you or someone you know needs help, visit our suicide prevention resources.
If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741-741.