It’s no secret that America faces a major mental and behavioral healthcare deficit. This has been the case for decades and was made much worse by the pandemic, which created new mental health challenges for children and adults while putting unprecedented strain on providers and care delivery systems.
Within this broader context of mental healthcare scarcity, what resources do exist are not evenly distributed. Mental health parity is a long-standing and vexing issue for providers, patients, and policymakers — one that resists easy solutions.
While providers like Oceans Behavioral Hospital recognize the challenges around parity and actively work to deliver care to underserved populations, an industry-wide response — and, frankly, policy changes — are necessary to achieve true equity.
That’s still some ways off. For now, let’s examine six barriers to mental healthcare access for patients and communities and their potential solutions.
1. Uneven Investment in Behavioral Healthcare Within Larger Population Centers
Even in larger population centers that are generally well-served by behavioral healthcare providers, resources are not distributed evenly. As is so often the case, behavioral health access is a function of demographic factors and a clear proxy for income. Higher-income subpopulations tend to have better access to inpatient and outpatient behavioral healthcare, all other things being equal.
2. Limited Provider and Facility Coverage in Small and Midsize Communities
Outside large population centers, the picture can be even bleaker. Due to a widespread provider shortage (more on that in a moment) and a defensible if the patient-unfriendly business case for centralizing care in major metropolitan areas, many behavioral healthcare systems simply don’t serve small and midsize communities.
This puts rural and small-town mental health patients and their loved ones in the difficult if the not impossible decision of traveling multiple hours each way to make outpatient appointments. Those requiring inpatient treatment must live — temporarily, at least — far from the friends and relatives upon whom they rely for support.
3. Uneven Adoption of Behavioral Telehealth
Underserved communities are ripe for behavioral telehealth adoption. And while the mental health industry significantly improved telehealth access during the pandemic, coverage remains uneven.
Coupled with an increase in the share of providers offering it, better telehealth coverage could do much to address widespread barriers to mental healthcare access. But many of the other factors we’re exploring here act to slow that expansion.
4. Persistent Stigma Around Mental and Behavioral Healthcare in Many Communities
Merely seeking help for suspected mental health issues remains a heroic act in many communities. According to data from the National Council for Mental Wellbeing, more than 30% of Americans and nearly 50% of Gen Z Americans have worried about people “judging” them for seeking mental healthcare. This begs two related questions. One, how many aren’t seeking help who should be? And two, how can we encourage them to reach out?
5. Lack of Payment Options for Many Would-Be Patients
The mental health industry’s payer landscape is notoriously complex even by the standards of the broader U.S. healthcare system. Setting aside social stigma, many Americans choose not to seek mental healthcare — or give up after trying for some time — because they believe (correctly or not) that they’ll need to pay out-of-pocket for the service.
This problem doesn’t only affect those with private insurance; Americans on Medicare and Medicaid are affected as well.
6. A General Provider Shortage That Impacts Care Quality and Follow-Ups
According to a Kaiser Family Foundation analysis, nearly 120 million Americans live in regions defined as Health Professional Shortage Areas (HSPAs) for mental health. These regions have fewer than the minimum number of mental health professionals per unit of population. For psychiatrists, that’s one per 30,000 people.
Thousands upon thousands of providers would be required to make up this shortfall, a workforce expansion that’s simply not realistic to expect in the short term. For now, and likely for the foreseeable future, this deficit impacts the quality of care and provider availability for follow-ups, among other metrics.
Everyone Deserves Equal Access to Quality Mental Healthcare
“Mental health parity” is much more than a buzzword. It’s a basic human right. Everyone, no matter their identity or geographic location, or economic status, deserves equal access to quality behavioral healthcare.
Unfortunately, we’re nowhere near achieving true mental health parity. If anything, the pandemic set back the cause of parity, undoing much of the work done by providers and patient advocates in the preceding decade. Despite advances in behavioral telehealth and some lessening of the stigma around care-seeking, the root causes of mental health inequity remain firmly entrenched.
It will take years to unearth them. In the meantime, let’s resolve never to lose sight of the most important piece of the parity equation: the patient. That’s who we work for, and that’s who stands to benefit from an improvement in the status quo.