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Two-Thirds of Insured Individuals With Behavioral Health Conditions Not Treated by Specialist
Despite having health insurance, about one-third of individuals diagnosed with a mental health condition did not receive any form of specialty care, such as individual therapy or psychiatric medication management, according to a report released this month by the not-for-profit mental healthcare advocacy group Inseparable.
The Inseparable report, “Improving Mental Health Care: The Access Report,” was developed using information and data compiled by the healthcare and actuarial consulting firm Milliman.
“When we commissioned the research from Milliman, we were seeking to better understand who is getting care and who isn't,” Inseparable founder Bill Smith said in a news release. “What we learned was shocking: Despite federal laws designed to ensure better access to mental health and substance use disorder treatment, people aren't getting the critical care that would ease suffering and save lives.”
Researchers pulled together data across multiple types of healthcare coverage—commercial insurance, Medicare fee-for-services (FFS), and Medicaid—and analyzed access to and affordability of treatment for behavioral health conditions in 2021. Their findings included the following:
- Just 33% of individuals diagnosed with a behavioral health condition received treatment from a behavioral health specialist. Those with Medicaid coverage had the highest rate of specialist care (44%), while those with Medicare FFS coverage had the lowest (15.7%). Milliman researchers noted that while some individuals received appropriate treatment through primary care or other providers, the firm’s finding that two-thirds of individuals with behavioral health conditions do not receive treatment from a specialist still indicates a significant gap in care access.
- Overall, 8% of emergency department visits included a primary diagnosis of a behavioral health condition, with Medicaid-covered individuals having the highest rate (12.9%), followed by Medicare FFS (7.3%) and those with commercial insurance (6.9%).
- More than half (52.7%) the US population lives in counties entirely designated as Mental Health Professional Shortage Areas, and just 27.7% of the psychiatrists needed to remove these shortages are available across the nation.
- Individuals living in areas with low behavioral health provider supply use behavioral healthcare services significantly less than those in areas with the highest supply.
- Psychiatrists are less likely to accept healthcare coverage of all types compared to other providers. The average self-pay cost for a 60-minute psychotherapy visit was $174.
“The findings underscore the urgent need for strategies to increase the availability and affordability of behavioral health services, particularly in states with high prevalence rates and low provider availability,” Milliman researchers wrote in the analysis supplied to Inseparable. “Strategies to increase healthcare coverage and reduce out-of-pocket costs could help to improve access to behavioral health services.
“It is critical to consider location and population factors when interpreting state-based results and considering implications for state or federal policy, insurance policies, practice guidelines, or other types of interventions.”
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