Why Is Improving Access to Mental Health Care Important?

Employers are becoming increasingly engaged in raising awareness about mental health conditions and creating a climate and culture that encourages employees to seek help when they need it. Yet, despite these efforts, access to care for people with mental health struggles remains challenging.¹

According to the 2022 National Survey on Drug Use and Health, only half of the people in the United States who had any mental illness in the past year received treatment.² Similarly, among people in the United States who needed treatment for substance use, only about 1 in 4 (24%) received substance use treatment in the previous year.

Of the reasons for these gaps, survey respondents frequently named access barriers.³ Specifically, approximately half of people with any mental illness and people with substance use problems said they did not know how or where to get treatment. Nearly 47% of people with any mental illness and almost 42% of those with substance use issues said they did not have health insurance coverage for treatment.

Other common barriers to mental health access include the high cost of treatment, the lack of treatment facilities or providers in a person’s geographic area, a lack of culturally diverse providers, and long wait times for appointments.⁴

Clearly, there are opportunities to better connect people in need with mental health care, and employers are well-positioned to help reverse these trends.

How Access to Care Affects Employees and Employers

Access to care is a critical problem in part because the effects of undiagnosed and/or untreated mental illness are wide-ranging and potentially serious.

Physical Effects

When people with mental disorders such as depression, bipolar disorders, and anxiety disorders experience longer delays in care, they are more likely to have multiple co-occurring chronic health problems than people who have faster access to care.⁵ These health conditions include:⁶

• Asthma
• Arthritis
• Musculoskeletal pain
• Chronic obstructive pulmonary disease
• Diabetes
• Heart disease
• Cancer
• Stroke
• Bowel disorders, such as Crohn’s disease and colitis

The presence of physical health problems in people with mental illness has downstream negative effects, further hindering the person’s ability to function, increasing their need to utilize health care (e.g., outpatient visits, hospitalization), and increasing healthcare spending.

Psychiatric and Functional Effects

Access to care is critical for helping people with mental illness maintain a positive prognosis, keep their symptoms from getting worse, and avoid developing additional menta health disorders.⁷

For instance, research shows that delays in care for depressive, bipolar, and anxiety disorders are associated with a worsening of mental health symptoms and functioning, the development of other co-occurring mental disorders, and an increased risk of suicide attempt.^8,9,10

For individuals with certain serious mental illnesses, such as psychotic disorders, lack of treatment often leads to a greater risk of hospitalization, more severe symptoms, worse response to medication once treatment is received, and an increased risk of involvement in the justice system.^11,12

Lack of access to care also negatively affects people’s everyday lives. Individuals with longer delays to diagnosis are more likely to report experiencing functional activity limitations, including in leisure activities, socializing, or taking care of oneself (e.g., maintaining personal hygiene).¹³

Work-Related Effects

In a 2022 survey of more than 2,000 U.S. adults, not being able to access care appeared to have a negative effect on the work lives of people with mental health and substance use problems.¹⁴ Specifically, 45% of people needing mental health care and 49% of people needing substance use care said not receiving treatment led to difficulties at work.

Tips for Employers: Increasing Access to Care

When employees have easy access to effective and timely mental health and substance use care, the result is a healthier, more productive, and higher-performing workforce.

To help make this a reality, the Center for Workplace Mental Health and the American Psychiatric Association joined forces to develop Recommendations for Improving Access to Mental Health and Substance Use Care. These recommendations were developed in consultation with thought leaders representing psychiatrists, large employers, health plans, business groups on health, and other mental health professionals.

In developing the recommendations, they identified five key priority areas in which employers and health plans can play a key role in improving access to mental health and substance use care. The recommendations provide detailed steps that employers, employer coalitions, and health plans can take to improve access to care. Below is a summary of the five areas to supplement the recommendations, which provide more detailed steps:

• Ensuring network adequacy: Employees who cannot access affordable care often go without, increasing the likelihood of missed workdays, poor performance, and symptom worsening. The recommendations call for health plans to provide employers with a detailed plan on steps they are taking to grow the provider network. This information will inform employers on network adequacy and open the opportunity to work together to overcome challenges in access to care.
• Staying compliant with mental health parity: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) requires that coverage for healthcare services for mental health and substance use conditions be comparable to coverage for medical and surgical care. In many cases, employers as plan sponsors maintain responsibility for parity compliance. Examples of parity non-compliance violations include higher co-pays, lower visit limits, overly restrictive fail-first policies, prior authorization requirements, and written treatment plan requirements. The MHPAEA guidance (.pdf) provides recommendations to increase access to quality health coverage for mental health and substance use conditions, and identify key questions employers can ask health plans to improve MHPAEA compliance and reduce risk of violations and penalties.
• Advancing measurement-based care: Screening should be increased to ensure early detection of depression and other conditions. The quality of care delivered should also be improved by closely tracking and reporting treatment progress and outcomes for mental health and substance use conditions. The recommendations identify a process for collaborating to create greater accountability.
• Expanding the collaborative care model (CoCM): Primary care providers play a key role in delivering mental health and substance use care, especially for common conditions, like depression and anxiety. Integrating mental health and primary care offers the opportunity to improve access to care, enhance outcomes, and lower overall healthcare costs. This approach, called CoCM, was designed to effectively deliver mental health and substance use care in primary care settings. The model works with a team that includes a primary care physician, the patient, a behavioral healthcare manager, and a psychiatric consultant.
• Expanding telepsychiatry: Given the shortage of psychiatrists in communities around the country and the opportunity to effectively connect to care using technology, the recommendations identify the steps needed to promote and expand the use of technology for employees to connect to care.

Resources

Employers can learn more about how to help prevent or reduce gaps in access to care for workers with mental health struggles:

• The American Psychiatric Association’s Center for Workplace Mental Health features a collection of employer resources, such as a listing of guides and toolkits to support employee mental health. This includes the comprehensive Mental Health Works planning guide.
• The Department of Labor offers a vast number of resources to help organizations better support employee mental health and connect workers to needed services.

Resources for the general public can be found below.

• Mental Health America has a webpage of resources to aid people with mental health concerns in finding and accessing treatment and other services.
• The Substance Abuse and Mental Health Services Administration developed a resource website of crisis and other help-seeking hotlines as well as a link to its treatment locator for people seeking services anywhere in the United States and its territories.
• The Centers for Disease Control and Prevention offers mental health access resources specific for populations with unique needs, such as older adults, veterans, and people experiencing abuse or intimate partner violence.