Access to behavioral health care remains a challenge

Access to behavioral health care remains a challenge for many Americans, participants at a recent conference said.

Hannah Locke, a senior analyst with the U.S. Government Accountability Office’s health care team, told the American Academy of Actuaries that the three main challenges to accessing behavioral health care are:

1. Limited access to network providers.
2. Structural problems of the mental health system.
3. Approval processes and coverage limitations.

Behavioral health problems affect millions of adults in the U.S., but relatively few receive treatment, Locke said. Of the 57.8 million adults with mental health issues in 2021, about 26.5 million received treatment in the past year, according to a study by the Substance Abuse and Mental Health Services Administration. Of the 44 million adults with substance use disorders, an estimated 2.1 million received treatment in a specialty facility in 2021.

Cost is cited as a key factor

When people with mental health problems were asked why they did not seek treatment, the main reason given was that they could not afford treatment. Those with a substance use disorder who did not receive treatment said their No. 1 reason for not seeking treatment was that they did not perceive they needed it.

Congress took a step toward improving access to behavioral health care by approving the Certified Community Behavioral Health Clinic model, which is designed to provide access to coordinated comprehensive behavioral health care, Locke said. CCBHCs are required to serve anyone seeking mental health or substance use care, regardless of their ability to pay, where they live, or age, including developmentally appropriate care for children and youth.

CCBHCs are reimbursed by state Medicaid programs using a prospective payment system with clinic-specific rates designed to cover expected costs, he explained.

The behavioral health system is also challenged by workforce shortages, Locke said.

SAMSHA found that nearly half of US counties did not have an active psychiatrist or addiction medicine specialist in 2020. The Department of Health Resources and Services has predicted a shortage of psychiatrists and addiction counselors by 2030.

Locke noted some of the challenges in recruiting and retaining behavioral health professionals.

1. Low reimbursement rates from payers combined with low earning potential for professionals.
2. There is a need to work with higher education to develop a pipeline into the profession.
3. Especially in rural areas, it is difficult to train and retain people in this profession.

Unity agenda mental health focus

The Biden administration’s unity agenda includes a focus on mental health, said Trina Dutta, SAMHSA’s chief of staff. The administration’s health strategy is structured around three elements:

1. Strong system power.
2. Connect more Americans to care.
3. Create a continuum of support.

SAMHSA’s priorities for 2023-26, he said:

1. Prevention of drug abuse and overdose. The main activity is to support the distribution of naloxone.
2. Increasing access to suicide prevention and mental health services. Key activities focus on expanding culturally competent services for 988 bios, including the use of American Sign Language, Spanish language services, and specialized communication support for the LGBTQ+ population under 25 years of age.
3. Promoting resilience and emotional health in children, youth and families. The key is to match the right child with the right intervention at the right time.
4. Integrating behavioral and physical health care. A key activity is to increase the knowledge and capacity of the health workforce.
5. Strengthening the Behavioral Health Workforce. A key activity is expanding the use of paraprofessionals and peers.

Susan Rupp is the editor-in-chief of InsuranceNewsNet. He previously served as communications director for the Insurance Agents Association and was an award-winning newspaper reporter and editor. Contact him [email protected]. Follow her on Twitter @INNsusan.

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