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 Did Not Receive Treatment
55.8% of adults with a mental illness received no treatment. Lack of access to treatment is slowly improving. In 2011, 59% of adults with a mental health problem did not receive any mental health treatment.
Reasons for not receiving treatment can be individual or systemic.
Making screening tools accessible would allow individuals to learn about, and address their mental health concerns. Additionally, establishing contact with a healthcare provider at onset is critical. The integration of behavioral health and general healthcare would ensure that individuals’ mental health conditions, and their physical manifestations are more quickly identified and treated.
The state prevalence of untreated adults with mental illness ranges from 41.4% in Massachusetts to 66.0% in Nevada.
Adults with AMI Reporting Unmet Need
One out of five (20.1%) adults with a mental illness report they are not able to get the treatment they need. Unlike the number of people with mental illness who did not receive treatment, the individuals who are reporting unmet need are seeking treatment and facing barriers to getting the help they need.
Where you live could determine whether you receive timely treatment: individuals living in states with the highest levels of unmet need (bottom 10) were 1.6 times more likely to have people report unmet need.
Across the country, several systemic barriers to accessing care exclude and marginalize individuals with a great need. These include the following:
- Lack of insurance or inadequate insurance
- Lack of available treatment providers
- Lack of available treatment types (inpatient treatment, individual therapy, intensive community services)
- 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 14.4% in Hawaii to 25.2% in the District of Columbia.
Adults with AMI who are Uninsured
14.7% (over 6.3 million) of adults with a mental illness remain uninsured.
Missouri (7.7%), South Carolina (2.7%), and Kansas (2.4%) had the largest increase in Adults with AMI who are Uninsured –three states that have not adopted Medicaid expansion.
With a national focus on health care access, the uninsured rate is improving (3% reduction).
Unfortunately, having insurance coverage does not mean access needed treatment.
56.5% of adults with mental illness received no past year treatment, and for those seeking treatment, 20.1% continue to report unmet treatment needs.
The state prevalence of uninsured adults with mental illness ranges from 3.3% in Massachusetts to 23.8% in South Carolina.
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.
People with mental health problems are more likely to have no insurance or to be on public insurance (43%).The inability to pay for treatment, due to high treatment costs and/or inadequate insurance coverage remains a barrier for those individuals despite being insured.
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
63.1% of youth with major depression do not receive any mental health treatment.
That means that 6 out of 10 young people who have depression and who are most at risk of suicidal thoughts, difficulty in school, and difficulty in relationships with others do not get the treatment needed to support them.
State-level budget cuts and coverage contraction has presented a challenge for federal programs, such as Medicaid, which is reported to have the greatest influence over mental health trends among children.
The state prevalence of untreated youth with depression ranges from 48.6% in Connecticut to 72.2% in Tennessee.
Youth with Severe MDE who Received Some Consistent Treatment
Nationally, only 23.4% of youth with severe depression receive some consistent treatment (7-25+ visits in a year).
These numbers speak on the need for increased funding for community-based treatments proven to work for high needs children. Treatments must be made accessible to children with mental health conditions and their family—regardless of income
The state prevalence of youth with severe depression who received some outpatient treatment ranges from 39.9% in Minnesota to 10.8% in Alaska.
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
Children and youth are more likely to have insurance coverage compared to adults.
Nationally, 7.7% of youth had private health insurance that did not cover mental or emotional problems.
Montana, Hawaii, New Jersey saw the largest increase in access to mental health coverage among children. These states have also had a significant increase in monthly Medicaid/Chip enrollment from Pre-ACA enrollment numbers.
Reduction in uncovered mental health care among those states are:
- Montana: 75% increase in monthly enrollment
- Hawaii: 20% increase in monthly enrollment
- New Jersey: 36% increase in monthly enrollment
- Ohio: 29% increase in monthly enrollment
Medicaid is the “largest single payer for mental health services”, often providing more comprehensive mental healthcare than most private insurances. Private insurance remains costly for many people. Market autonomy, also allows private insurers to determine coverage based on levels of mental health conditions.
Under these circumstances severe mental illnesses receive more coverage, possibly deterring individuals from seeking help until they reached a point of crisis.
The state prevalence of children lacking mental health coverage ranges from 2.4% in Massachusetts to 18.4% in Mississippi.
Students Identified with Emotional Disturbance for an Individualized Education Program
Only .763% of students are identified as having an Emotional Disturbance (ED) for an Individualized Education Program (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. Often youth with emotional or mental health problems are identified as having behavioral issues rather than an emotional or mental health problem.
Mental illness under the guise of a “behavioral issue”, along with lower expectations for certain populations, and a lack of education in parents concerning the effects of trauma, prevent many high-risk students from receiving IEPs (Sarah Ozment, M Ed. Early Childhood Special Education, Interview, September 2017).
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 for and IEP ranges from 26.05 per 1,000 students in Vermont to 1.91 per 1,000 students in Arkansas.
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.
Over 4,000 areas across the US, containing more than 110,000,000 million people, are considered mental health professional shortage areas. These are individuals that are left to travel hours or across state lines to access services.Areas that are rural, and have low- income per capita are most affected.
Although the ACA gave millions of individuals with mental health conditions the chance to seek treatment, these individuals now face a shortage of mental health providers. The demand, along with high turnover rates amongst mental health professionals (mainly due to a lack of social support and compensation) has created a “workforce crisis”.
To make matters worse, the addition of low reimbursement rates combined with a limited number of providers and high demand for help means that many do not accept insurance, forcing families and individuals to pay high out-of-pocket fees or go without care.
Peer support specialists, workforce development programs, telehealth, or primary care models like Collaborative Care are possible solutions to the significant mental health workforce gap in the states.
The state rate of mental health workforce ranges from 200:1 in Massachusetts to 1,200:1 in Alabama.