- Patient access to mental health (MH) and substance use disorder (SUD) treatment leaves something to be desired for Massachusetts residents, with a majority of non-elderly adults reporting access issues in a recent Blue Cross Blue Shield of Massachusetts Foundation report.
The report, which used data from the 2018 Massachusetts Health Reform Survey (MHRS), revealed that despite a strong MH and SUD provider workforce and near universal healthcare coverage, patients still struggle to access care.
Twenty-three percent of all respondents said they sought MH or SUD treatment for themselves or a family member in 2018. Nearly 16 percent of those respondents sought care for themselves personally as opposed to for a family member. These respondents tended to be low-income patients who were young, white, and female.
Fifty-six percent of those who sought MH or SUD treatment in 2018 reported challenges in doing so. Forty-six percent of respondents said they struggled to find a provider and 43 percent said it was difficult to obtain an appointment in a timely manner.
Issues in finding a provider included being told that a provider does not accept health insurance (11 percent), that they did not accept the type of insurance the patient had (36 percent), or that the provider is not accepting new patients (36 percent).
Individuals facing care access challenges reported that they truly needed the care, the report added. Fifty-four percent of those who sought MH or SUD treatment reported that their MH or SUD status was fair or poor and that those health issues had kept them from work or usual activities for any of the previous 30 days.
The report authors added that 14 percent of respondents who had not sought MH or SUD treatment still reported fair or poor mental and behavioral health status. This suggests that some patients who need MH or SUD attention are not seeking those services, raising questions about stigma as a mental health access barrier.
These issues persist even when patients have access to health payer coverage. Ninety-six percent of those who could not access MH or SUD treatment had insurance coverage at the time of the survey and 84 percent had insurance during the previous 12 months as well.
Eighty-eight percent of these patients said they had a usual place they visit when they are feeling sick that is not the ED, and 89 percent said they had a wellness or primary care visit within the previous 12 months. This suggests that patients have a strong network for care access for physical health, but that mental healthcare treatment options leave something to be desired.
Instead, patients are accessing inappropriate facilities for MH or SUD treatment needs. For example, 12 percent of respondents reported visiting the emergency department for their MH needs, despite the high costs of the ED.
About half of those ED visits were for MH issues that the patient acknowledged were not emergencies.
The issues plaguing patient access to MH or SUD treatment in Massachusetts are similar to the barriers seen across the country, the report authors said.
“Several factors are seen as creating barriers to MH/SUDs care in Massachusetts, including a geographic mismatch in MH/SUDs provider supply across areas of the state, the fragmented MH/SUDs care system, and an unwillingness on the part of some MH/SUDs providers to accept health insurance,” the report explained.
As such, many of the potential solutions to these problems are similar to those proposed across the country. For example, creating incentive programs to supplement the provider workforce, reworking health payer models, and creating better care coordination between physical and mental health providers could prevail.
“Massachusetts has programs underway that are intended to expand the overall supply of MH/SUDs providers and address the geographic mismatch among providers (e.g., student loan repayment programs and investments in community mental health centers, behavioral health community partners, and telehealth, along with expanded SUD services and training),” the report authors concluded.
“Expanding the number of providers who are willing to take health insurance coverage, particularly MassHealth, likely will require an increase in MH/SUDs reimbursement rates, along with simplified administrative processes to make participation in insurance programs and provision of treatment for patients less onerous on providers.”