National Council Survey Examines Barriers to Access


An alarming number of people cope with a substance use or mental health challenge.

The number of adults reporting symptoms of anxiety or depressive disorder nearly tripled during the pandemic, from 11.0% in 2019 to 31.6% in the fall of 2021, according to the Kaiser Family Foundation. The Centers for Disease Control and Prevention on May 11 reported that drug overdose deaths increased 15% in 2021 to nearly 108,000 deaths.

New data we have released reveals another alarming fact: 43% of U.S. adults who say they needed substance use or mental health care in the past 12 months did not receive that care, according to a national survey of more than 2,000 U.S. adults conducted online by The Harris Poll on behalf of the National Council for Mental Wellbeing.

So, why aren’t we doing more to help people overcome substance use and mental health challenges? We must work harder to answer that question.

While 43% of U.S. adults who say they needed substance use or mental health care in the past 12 months did not receive that care, just 21% of those who needed primary care and did not receive it, according to data from the new report, 2022 Access to Care Survey.

Majorities of U.S. adults who needed care cited difficulties getting it, including those who did receive care. The primary barriers to access for those with unmet needs for substance use or mental health challenges over the past 12 months include cost-related issues (no insurance, out-of-pocket costs, 31% and 37%, respectively), the inability to find a conveniently located provider (22% and 28%, respectively) and the inability to get an appointment immediately when they needed care (31% and 25%, respectively).

Those who did receive substance use or mental health care over the past 12 months also cited difficulties in getting that care:

  • 81% of U.S. adults who received substance use care had trouble getting care.
  • 67% of U.S. adults who received mental health care experienced difficulties getting care.

The survey also found that nearly 3 in 5 U.S. adults believe it is easier (59%) and faster (59%) to get substance use or mental health care if you pay out-of-pocket versus using insurance.In addition, 71% of U.S. adults would be more likely to get substance use or mental health care if they could receive it through their primary care doctor, if they needed it, and 67% think it’s harder to find a mental health care provider than it is to find a physical health care provider.

And as we observe Pride Month, it’s important to note that people want providers who are a good cultural fit. Those with unmet needs for a substance use challenge identified their inability to find a provider who was a good cultural fit (17%) as a barrier to access, while those with unmet needs for a mental health challenge said the inability to find a provider who was a good cultural fit (13%) represented a barrier to access.

So, what can we do? Our will to correct these problems and help people find the care they need and deserve must be stronger than the challenges we face. We cannot be mentally well and actively thriving if we are unable to access services.

The industry has difficulty fulfilling the need for treatment in communities across the country due to a shortage of mental health and substance use professionals. Communities need more substance use and mental health professionals. The lack of psychiatrists, nurse practitioners, social workers, case managers and more limits the ability to provide care.

Passing the bipartisan Mental Health Access Improvement Act (S. 828/H.R. 432) would allow marriage and family therapists and mental health counselors receive reimbursement from Medicare for their services. Passing the Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act (S. 2144/H.R. 2767) would allow peer support specialists to participate in providing integrated mental health services, the care coordinated by both primary and behavioral health clinicians, to Medicare beneficiaries.

Providing more funding for the Health Resources and Services Administration’s Substance Use Disorder Treatment and Recovery Loan Repayment Program can help bolster the substance use workforce by offering prospective workers a greater incentive to enter the field.

Curbing our nation’s overdose epidemic requires removing unnecessary barriers to medication-assisted treatment (MAT), standardizing prescriber education practices and expanding access to care for our nation’s most vulnerable populations. Passage of the Mainstreaming Addiction Treatment (MAT) Act (S. 445/H.R. 1384), the Medication Access and Training Expansion (MATE) Act (S.2235/H.R. 2067) and the Medicaid Reentry Act (S. 285/H.R. 955) will help enormously.

We can also permanently lift restrictions on telehealth. During the pandemic, many organizations quickly transitioned from in-person services to telehealth and technology-assisted services, and this increased use of technology is expected to continue.
Finally, stigma represents a significant barrier. We must overcome the fear and discrimination that so often prevent people from seeking treatment. Acknowledging the need for treatment provides hope that mental wellbeing – thriving regardless of a mental health or substance use challenge – is within reach.

The opportunity to be healthy and achieve wellbeing eludes many people. But we have so many opportunities to improve care for those with substance use and mental health challenges. Let’s take advantage of those opportunities by removing barriers to access.

Our mental wellbeing depends on it.

Check out our 2022 Access to Care Survey here.


Charles Ingoglia, MSW
(he/him/his) President and CEO
National Council for Mental Wellbeing
See bio