Access to mental health services is a significant issue for individuals in the US, even for those who have adequate health insurance. As we discussed in our article “Mental Health Care Parity (20 Years Later),” parity may be the law, but access to mental health services is more complicated than simply passing laws. There’s enforcement and oversight of the law, a topic we’ll discuss in greater depth in a future article. And on a more basic level, there are issues of availability, affordability and awareness, all of which are obstacles in seeking mental health services.
“About 55% of U.S. counties, all rural, have no practicing psychiatrists, psychologists or social workers.” So for someone in a rural area, that means going without or traveling farther away, which then equates to more time and money. And even in a more populated suburban area like the Chicagoland area, long wait times to see a psychiatrist is not uncommon, especially for a child psychiatrist.
Kathy K., whose teenage daughter had been seeing a psychologist for several months, was referred to a pediatric psychiatrist for medication to help with her depression. “We waited almost 3 months before we could get in to see someone. I must have called a half dozen or more doctors and they just kept saying ‘If you think she’s suicidal, take her to the emergency room.’ Now how am I, as a parent, supposed to know whether my daughter’s deepening depression and thoughts about suicide meant she simply needed to be medicated or if she needed to be committed to an in-patient facility? I just hoped and prayed that everything would be okay until we could get in to see someone.” When hoping and praying and excessive wait times are the norm, even in heavily populated, suburban areas, we have to agree there’s a significant issue when it comes to access to mental health services. Imagine if you were in physical distress and had to wait 3 months to see a doctor?
Beyond access, there’s the issue of affordability. Simply having insurance doesn’t ensure access to mental health care. For example, a 2014 study showed vast differences in the number of psychiatrists that accepted private insurance as compared to other medical specialties (55% vs. 89%). The same trend was seen in Medicare and Medicaid acceptance rates among psychiatrists vs. other medical specialties (Medicare: 55% vs. 86%; Medicaid 43% vs. 73%). Although study participants weren’t specifically asked why they didn’t accept insurance, the complexity of mental health reimbursement is a well-established obstacle for mental health care providers. So you may be able to get an appointment, but when nearly half of the providers in your area don’t accept insurance, is that really accessible?
Finally, stigma and lack of understanding of mental health remains an issue. “Mental health literacy seems to have a promising effect on care seeking . . . when people understand that mental disorders are not the result of moral failings or limited will power, but are legitimate illnesses that are responsive to specific treatments, much of the negative stereotyping may dissipate.”  While it’s true that there is less of a stigma than there used to be, we still have a long way to go before people truly see mental illness in the same light as they see physical illness.
In addition to enforcing mental health parity laws, we should also be looking at ways to improve overall access to mental health services. More education and awareness about mental health, including promoting mental health screenings (see our article on Proactive Mental Health), is a good place to start. But we also need to take a long, hard look at a system that makes it THIS difficult for individuals to have access to providers. Would we tolerate this if we were talking about physical health? That seems doubtful. Nor should we tolerate it with respect to mental health either.