Barriers to access compound mental health and substance use challenges, erode wellbeing and lead to problems at work and home.
A staggering 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, and numerous barriers to access stand between them and needed treatment, according to a new 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.
Barriers to access may complicate or delay treatment, according to the 2022 Access to Care Survey. Cost, availability, wait times, a lack of diversity and proximity to care all represent significant obstacles for all those seeking care for substance use and mental health challenges – those who were able to access care and those who weren’t.
“Substance use and mental health challenges and barriers to access are enacting a crushing toll on those who seek treatment and cannot get it. The COVID-19 pandemic led to increased substance use and mental health challenges for people of all ages and all backgrounds, yet too many people are not getting the care they need. It is not enough to acknowledge the problem. We must break down these barriers.”National Council for Mental Wellbeing President and CEO Chuck Ingoglia
Too Many are Not Getting Care
The new survey provides a picture of substantial demand, but with large swaths of the population missing opportunities to get care. The unmet demand for substance use and mental health care is more than double the unmet demand for physical health needs, according to the survey. Specifically:
- 42% of U.S. adults report needing mental health care over the past 12 months and 24% report needing substance use care during that timeframe.
- 43% of U.S. adults who needed mental health care or substance use care (also 43%) in the past 12 months did not receive it, compared to 21% of those who needed primary care and did not receive it.
“It is a national disgrace that 43% of U.S. adults who needed care are unable to get that care for mental health and substance use challenges. We are in a mental health and substance use crisis. Failing to eliminate barriers to access will only worsen this new public health emergency. In conducting this survey, we at the National Council do not seek to simply call attention to a national crisis in health care. It is our goal to begin a national discussion that will pave the way to lasting solutions.”Chuck Ingoglia
Barriers to Care are Universal
All U.S. adults who needed care cite difficulties getting it, including those who actually got care. The primary barriers to access for those with unmet needs for mental health or substance use challenges over the past 12 months include:
- Cost-related issues (no insurance, out-of-pocket costs) prevented 37% from getting mental health care and 31% from receiving substance use care.
- Inability to find a conveniently located provider prevented 28% from getting mental health care and 22% from getting substance use care. In some rural areas, providers may be hours away.
- Inability to find a provider who offers a visit format people feel comfortable with (e.g., in-person, telehealth) prevented 25% from getting mental health care and 31% from receiving substance use care.
- Inability to get an appointment immediately when they needed care prevented 21% from receiving mental health care and 28% from receiving substance use care. Wait times can range from weeks to months in some areas.
Those who did receive mental health or substance use care over the past 12 months also cite 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 many U.S. adults, overall, believe insurance-related issues complicate access. Nearly 3 in 5 U.S. adults believe it is easier (59%) and faster (59%) to get mental health or substance use care if you pay out-of-pocket versus using insurance.In addition, 71% of U.S. adults would be more likely to get mental health or substance use 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.
Peoples’ Lives are Impacted by Unmet Needs
Those with unmet mental health and substance use care needs say not receiving care had an impact on their lives. Among those who did not receive needed mental health care:
- 50% reported personal relationship issues as a result of not getting care.
- 45% reported work issues.
- 44% reported a decline in mental wellbeing.
Among those who did not receive needed substance use care:
- 49% reported work issues as a result of not getting care.
- 43% reported personal relationship issues.
- 37% reported a decline in mental wellbeing.
Our Workforce is not as Diverse as the People We Serve
The survey revealed that a workforce shortage may have made access to care more difficult. Those who received needed mental health or substance use care, as well as those who did not had difficulty finding culturally competent care. Many adults feel there is a lack of providers available to address cultural needs:
- 13% who didn’t get needed mental health care cite that it was because they couldn’t find a provider who was a good cultural fit, and 17% who didn’t get needed substance use care say the same.
- 17% who received mental health care in the past 12 months say they struggled to get care because they were unable to find a provider who was a good cultural fit, and 24% who received substance use care say the same.
- 61% of U.S. adults overall feel there are not enough mental health care providers who are trained to address issues specific to race, ethnicity, sexual orientation or socioeconomic status.
“Recruiting more mental health and substance use professionals must be a top priority – and that workforce must reflect the rich diversity of our nation. We won’t be able to increase access to care or meet the historic demand for mental health and substance use care with an inadequate number of people employed to provide treatment. Improving Medicare, Medicaid and non-Medicaid-funded program reimbursement rates will allow employers to boost salaries and other financial incentives that will help with recruitment and retention.”Chuck Ingoglia
The bipartisan Excellence in Mental Health and Addiction Treatment Act (S. 2069/H.R. 4323) would expand Certified Community Behavioral Health Clinics (CCBHCs), allowing more clinics to take advantage of specialized funding for staff recruitment and retention. CCBHCs are specialized clinics that offer expanded mental health and substance use services – CCBHCs on average were able to hire 41 new positions per clinic. Passing the Excellence Act would give every state the opportunity to expand CCBHCs and expand access to lifesaving services nationwide.
Additional workforce-focused legislation includes the Mental Health Access Improvement Act (S. 828/H.R. 432), which would allow marriage and family therapists and mental health counselors to receive reimbursement from Medicare for their services, adding an estimated 225,000 providers to the Medicare mental health workforce. 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.
Men and Younger People are Most Impacted
The need for care is greatest among men and younger adults. Men are more likely than women to say they needed substance use care in the past 12 months (30% vs. 19%), and Gen Z (ages 18-25) and Millennials (ages 26-41) are more likely than Gen X (ages 42-57) and Boomers (ages 58-76) to say they needed both mental health (59% and 64% vs. 42% and 18%) and substance use care (38% and 42% vs. 21% and 7%) in the past 12 months. Whether they receive the care they need likely depends on their ability to overcome the many obstacles they encounter.
“We know overdose deaths in 2021 reached a record level and that people with substance use challenges need support and we know people of all backgrounds continue to struggle with their mental health and need support. We cannot continue to support a system that propagates barriers and inequity in care. Those with unmet needs are especially imperiled. The sooner we find the resources and political will to respond, the sooner we will be able to meaningfully address the lingering effects of the pandemic.”Chuck Ingoglia
Solutions to eliminating barriers to access
To eliminate barriers to access we must:
- Overcome the workforce shortage by passing the bipartisan Mental Health Access Improvement Act ( S. 28/H.R. 432), which would allow marriage and family therapists and mental health counselors receive reimbursement from Medicare for their services, and the Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act (S. 2144/H.R. 2767), which 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. The legislation also would provide a comprehensive definition of peer support specialists in the Medicare program.
- 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.
- Continue to invest in Certified Community Behavioral Health Clinics (CCBHCs) by passing the Excellence Act (S. 2069/H.R. 4323). CCBHCs provide a full array of services and supports, integrated with primary care and coordinated with other social service providers, reduce wait times, expand states’ capacity to address the overdose crisis and establish innovative partnerships with law enforcement, schools and hospitals to improve care, reduce recidivism and prevent hospital readmissions and will also help communities bolster the resources needed to provide mental health and substance use treatment.
- Improve our understanding of substance use challenges. People with substance use challenges can and do recover. We can do much more to reduce overdose deaths by introducing evidence-based prevention, harm reduction and treatment strategies and promoting recovery-oriented systems of care and support.
- Improve health equity because the opportunity to be healthy and achieve mental wellbeing eludes many people. Despite demand for mental health and substance use treatment, only one in three Black Americans in need of mental health care receives treatment, according to the American Psychiatric Association.
- Shift to an integrated model of care. Integrating primary care with treatment for mental health and substance use challenges increases efficiency, saves money and improve outcomes.
- Make a greater commitment to ensuring the success of 988, the new three-digit number for the National Suicide Prevention Lifeline scheduled to go live on July 16, 2022. The new dialing code will not immediately replace the current lifeline number – 1-800-273-TALK (8255) – but will offer an easy-to-remember option. This ambitious undertaking will require significant investment and coordination over the coming years to realize and fulfill its potential – passing the 9-8-8 Implementation Act of 2022 (H.R.7116) will help ensure people dialing or texting 988 have someone to call, someone to come, and somewhere to go.
This survey was conducted online within the United States by The Harris Poll on behalf of National Council for Mental Wellbeing from April 26-28, 2022, among 2,053 U.S. adults ages 18 and older. The sampling precision of Harris online polls is measured by using a Bayesian credible interval. For this study, the sample data is accurate to within + 2.8 percentage points using a 95% confidence level. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact the National Council for Mental Wellbeing.
About The National Council
Founded in 1969, the National Council for Mental Wellbeing is a membership organization that drives policy and social change on behalf of over 3,100 mental health and substance use treatment organizations and the more than 10 million children, adults and families they serve. We advocate for policies to ensure equitable access to high-quality services. We build the capacity of mental health and substance use treatment organizations. And we promote greater understanding of mental wellbeing as a core component of comprehensive health and health care. Through our Mental Health First Aid (MHFA) program, we have trained more than 2.6 million people in the U.S. to identify, understand and respond to signs and symptoms of mental health and substance use challenges.