Key Barriers Limiting Patient Access to Mental Healthcare

August 07, 2019 - Patients all across the country experience some sort of mental health issue every day. But instead of visiting the doctor like they might for a sprained ankle or chest pains, these individuals face considerable patient access barriers keeping them out of the mental healthcare setting.

The National Alliance on Mental Illness (NAMI) reports that one-in-four individuals experiences a mental illness each year, underscoring a critical need for mental healthcare access across all patient populations. This is a pervasive issue that warrants the kind of attention other chronic diseases often receive.

But access to mental healthcare isn’t exactly happening, as millions of Americans are going without access to care, per Mental Health America.

That limited care access is not for lack of patient motivation. A 2018 survey from the National Council on Behavioral Health (NCBH) showed that 56 percent of patients want to access a mental healthcare provider, but many face care barriers.

Limited health insurance access or in-network care are keeping many patients from visiting a mental healthcare professional. And even when a patient can find an affordable provider who will accept insurance, clinician shortages, fragmented care, and societal stigma are getting in the way of adequate care access.

Below, PatientEngagementHIT.com outlines some of the barriers patients may face when accessing mental healthcare.

Mental health clinician shortage

One of the primary causes for limited mental healthcare access is logical – there simply are may not be enough qualified mental health professionals to meet demand. The nation is currently staring down a significant clinician shortage, and the mental health specialty is not immune to this.

There are mental health professional shortage areas in every state across the United States, according to 2018 data from the Kaiser Family Foundation. The nation needs just over 7,000 more mental health clinicians to fill the provider shortage.

Currently, only about one-quarter of the nation’s mental health provider needs are met, a figure KFF calculated by dividing the number of available psychiatrists by the number the US needs to have filled its clinician shortage.

And, ultimately, this clinician shortage is making it hard for patients to access care. The NCBH survey revealed that 31 percent of patients faced a mental health appointment wait time longer than one week, which can have a severe impact on a patient who is in crisis.

Patients also have to travel long distances to visit a mental health clinician, with 46 percent of patients reporting that they or someone they know has had to travel more than an hour to access care in a timely manner. These travel distances can be prohibitive for patients, especially those who lack access to reliable transportation or the social supports that enable them to take time to travel to the doctor, such as childcare or paid time off from work.

Industry professionals have proposed some solutions to these issues. Telehealth, for example, could be a viable option for filling an access gap, but only 7 percent of patients have tried it thus far, according to NCBH. Forty-five percent of those who have not used telehealth said they would be open to the possibility.

However, telehealth does have its limitations, specifically in that it does not actually quell the mental health clinician shortage. A qualified psychiatrist or mental health counselor must be on the line for those telehealth consults. Telehealth presents an avenue to access for patients in particular mental health deserts.

Instead, the industry must focus on recruiting enough mental health professionals to address the looming clinician shortage.

Limited mental health access parity

Even when there is a mental health professional available, patients often face challenges identifying one who will accept their insurance. Narrow networks make it hard for patients to access mental healthcare at an affordable price.

Data from a 2018 National Alliance of Healthcare Purchaser Coalitions report noted that mental health access is more difficult than physical health access because there are fewer in-network options for patients.

Looking at eight common employer-sponsored health plans, researchers found that patients had to access out-of-network care for mental health 13 percent of the time. Patients only had to access out-of-network care for physical health 5 percent of the time, highlighting that patients have more in-network options for physical healthcare.

What the researchers couldn’t ascertain was the number of patients who did not access mental healthcare at all because they had no in-network options. Out-of-network care is known for being exceptionally costly for the patient. If a patient can only access out-of-network providers, they may choose to go without care altogether.

The NCBH survey confirms these findings, revealing that 42 percent of patients see high cost and limited insurance coverage as their main barriers to accessing mental healthcare. As patients face limited options for in-network mental healthcare, they either face large medical bills or are unable to visit a medical professional at all.

Fragmented mental and physical health access

Creating parity is not necessarily enough, many healthcare experts state. Organizations need to integrate their mental and physical healthcare offerings in order to ensure adequate care access, according to a 2018 paper in NEJM Catalyst.

“In the US, historically we have separated out mental and behavioral illnesses from physical illness,” said Amy Compton-Phillips, MD, executive vice president and chief clinical officer for Providence St. Joseph Health and theme leader for NEJM Catalyst’s Care Redesign sector. “What we are learning – at a pretty high cost – is that having two separate and unequal systems of care results in suboptimal treatment of a patient.”

Most organizations say they are falling short in offering mental healthcare to their patients, with just about half of providers saying their mental health offerings are inadequate. And although 77 percent say they have some sort of mental health offering within their clinics, most of them say this offering is not expansive and does not emphasize a holistic view of wellness.

Overall, 33 percent of providers say care fragmentation is a barrier to sufficient mental healthcare access.

Organizations should be wary of simply layering mental healthcare over primary care, or just offering the two services in tandem, Compton-Phillips and the paper authors noted.

Instead, conducting a community health needs assessment will help uncover the issues that can impact care access that extend beyond the scope of the clinician office. Using primary care to address domestic violence issues could close the gap to mental healthcare access, for example.

This strategy will require health data interoperability and information sharing between patient, primary care provider, and mental health specialist. However, a holistic approach to medicine will ideally break down the siloes that have so long separated care.

Social stigma and limited mental health awareness

Often, barriers to mental healthcare access are cultural, as patients feel the pressure of societal stigma and avoid visiting mental health professionals.

Thirty-one percent of respondents in the NCBH survey said they wanted to access mental healthcare but were worried about what others would think of them. Twenty-one percent said they did end up accessing mental healthcare but lied about having visited a mental health clinic.

Issues with social stigma varied among age brackets, the survey authors pointed out. Just under half of younger, Generation Z patients said they feared social stigma, compared to 40 percent of Millennial patients. Thirty percent of Generation X said they had concerns about stigma and mental health while 20 percent of Baby Boomers said the same.

But social stigma is doing more than just keeping some patients away from the mental health clinic; it is also obstructing societal awareness about mental health and making it more difficult to know about and navigate the healthcare industry.

According to the NCBH survey, very few patients can actually navigate the mental healthcare space. Twenty-nine percent of respondents said they wanted to access mental healthcare for themselves or a loved one but did not because they did not know where to go.

Twenty-one percent of respondents said they wanted to access mental healthcare but could not because of reasons outside of their control, although the survey did not detail what those reasons were.

This trend is exacerbated among low-income patients. Compared to their middle- and high-income counterparts, low-income patients are less likely to know where to access mental healthcare and more likely to visit a community center for treatment rather than a specialized mental health clinic.

Ultimately, it will take an industry culture shift to preserve patient access to mental healthcare. Through that shift, leaders can focus on creating coverage parity between physical and mental health and address the key limitations barring patients from accessing care.