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Mental Healthcare Access Shrinks as Patient Demand Grows

Nearly eight million US adults have a mental health condition, but mental healthcare access is often limited, hindering patient quality of life.

Patient access to mental healthcare is on the decline, one study shows.

Source: Thinkstock

By Sara Heath

- More patients are struggling with mental healthcare access than ever before, despite the needs from a growing patient population, according to a study from NYU Langone Medical Center.

In an assessment of survey responses to the National Health Interview Survey between 2006 and 2014, NYU researchers found that the number of patients experiencing serious psychological distress (SPD) is growing. SPD indicates patients with some kind of mental health concern that must be addressed by a mental health clinician.

“SPD combines feelings of sadness, worthlessness, and restlessness that are hazardous enough to impair people's physical well-being,” the research team explained.

The survey showed that between 2006 and 2014, the number of patients experiencing SPD grew from about 3 percent to 3.4 percent. As of 2014, approximately 8.3 million adult patients had SPD.

Despite the growing patient population, treatment access is shrinking, the researchers found. After assessing survey responses for healthcare coverage, care access, ability to pay medical bills, and limitations to daily activities, the researchers found that patients with mental health concerns are worse off than they were nearly 10 years ago.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

In 2014, 9.5 percent of patients with SPD did not have sufficient health insurance coverage that would enable them to see a mental health clinician. This is up from 9 percent in 2006.

Patients with SPD additionally experienced more treatment delays in 2014, rising to 10.5 percent. In 2006, that number was 9.5 percent.

Patients with mental health concerns also reported growing financial concerns. In 2014, 9.9 percent of patients with SPD could not afford to pay for their psychiatric medications, compared to 8.7 percent in 2006.

Overall, these care access barriers kept patients from receiving necessary treatments, posing a negative impact on their everyday quality of life. Patients with SPD were 3.6 times more likely to experience quality of life limitations, and 1.8 times more likely to experience work and employment barriers.

"Based on our data, we estimate that millions of Americans have a level of emotional functioning that leads to lower quality of life and life expectancy," lead author Judith Weissman, PhD, JD, said in a statement. "Our study may also help explain why the US suicide rate is up to 43,000 people each year."

READ MORE: How PCPs Can Improve Mental Health Communication, Care Value

The study did not assess the reasons why patients with SPD experience these limitations at a growing rate, opening up an area of future research.

However, Weissman, who is also a research manager in the Department of Medicine at NYU Langone, said it is peculiar that patients face these barriers in the wake of the Affordable Care Act and the 2008 Mental Health Parity and Addiction Equity Act. Going forward, the study’s results can point to further assessments of the ACA’s effects on healthcare access.

"Although our analysis does not give concrete reasons why mental health services are diminishing, it could be from shortages in professional help, increased costs of care not covered by insurance, the great recession, and other reasons worthy of further investigation," Weissman explained.

Healthcare professionals, especially primary care physicians, need to be doing more to integrate behavioral and mental healthcare into regular office visits, said senior investigator Cheryl Pegus, MD, MPH. In doing so, clinicians can better identify patients with SPD and direct them to the appropriate care sources.

"Utilizing tools at the time of intake on all patients allows us to collect important data and devise strategies for care," said Pegus, a director of general internal medicine and clinical innovation at NYU Langone.

READ MORE: Reviewing Medicaid’s Role in Boosting Patient Access to Care

"Our study supports health policies designed to incorporate mental health services and screenings into every physician's practice through the use of electronic medical records, and by providing training for all health care professionals, as well as the right resources for patients," Pegus explained.

Healthcare professionals have long lauded a care coordination and integrated care delivery approach to mental healthcare.

A September 2016 op-ed in the Journal of the American Medical Association contended that patients who experience coordinated care between their primary care and mental healthcare providers see better clinical results and easier care access.

“Despite the availability of effective care models, identifying and engaging patients in primary care with behavioral health problems has proven difficult,” wrote article authors James Knickman, PhD, Ranga Krishnan, MB, ChB, and Harold Pincus, MD.

“Moreover, the United States needs to solve the problem of providing access and building the capacity to meet the needs of even those who are already engaged in care,” the trio continued. “At the same time, individuals with severe mental health and substance use disorders have difficulty accessing effective primary and preventive care for chronic medical conditions.”

Other research has indicated the integrated mental healthcare delivery can lead to better overall patient wellness, cutting depression scores on by the Patient Health Questionnaire (PHQ-9) by up to 50 percent.

“The majority of interviewed patients receiving integrated care reported that having the behavioral health clinician (BHC) and primary care clinician as part of the same team and under the same roof was beneficial,” the study said. “They appreciated the care they received, and that their clinicians were working and talking with each other.”

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