US Mental Illness Care Access Inadequate Despite Coverage Expansions

The United States’ capability to meet the rising needs for mental health services is speedily deteriorating, at the same time that more Americans than ever are suffering from mental and emotional distress, according to new findings from researchers at NYU Langone Medical Center.

Their analysis of federal health information data concluded that 3.4 percent of the U.S. population, or more than 8.3 million, adult Americans suffer from serious psychological distress, or SPD. Serious psychological distress refers to feelings of sadness, worthlessness, and restlessness that are hazardous enough to impair physical well being, according to the Centers for Disease Control and Prevention.

The research was based on data from the CDC’s annual National Health Interview Survey. Previous survey estimates had number of Americans suffering from SPD at 3 percent or less.

Mental Health Care Disparities

The results could be driven by an array of factors, including lack of health insurance, poor access to health care services, insufficient mental health coverage, or an inability to pay for psychiatric medications, says lead study investigator Judith Weissman, PhD, JD, a research manager in the Department of Medicine at NYU Langone.

Weissman said the situation seems to have worsened, even though the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act (ACA) include provisions intended to help lower insurance coverage disparities for people with mental health issues. She added that the new report can serve as a baseline for evaluating the impact of the ACA and in identifying disparities in treating the mentally ill.

The research team estimated that almost one in 10 psychologically distressed Americans (9.5 percent) in 2014 did not have health insurance that would give them access to a psychiatrist or counselor. This is a modest upturn from 2006, when nine percent lacked any insurance.

About 10.5 percent in 2014 experienced delays in getting professional help due to insufficient mental health coverage, while 9.5 percent said they experienced such delays in 2006. And 9.9 percent could not afford to pay for their psychiatric medications in 2014, up from 8.7 percent in 2006.

Suicide Rate

Throughout the run of the survey from the years 2006 to 2014, health care services access deteriorated for people suffering from severe distress compared to those without SPD.

“Based on our data, we estimate that millions of Americans have a level of emotional functioning that leads to lower quality of life and life expectancy,” said Weissman. “Our study may also help explain why the U.S. suicide rate is up to 43,000 people each year.”

She says her group’s next research report will detail how underdiagnosis of SPD impacts physician practices and encourages overuse of other healthcare services.

More than 35,000 U.S. households, involving more than 200,000 Americans between the ages of 18 and 64, in all states and across all ethnic and socioeconomic groups, participate in the yearly survey.

Judith Weissman, Ph.D., J.D., David Russell, Ph.D., Melanie Jay, M.D., M.S., Jeannette M. Beasley, Ph.D., R.D., Dolores Malaspina, M.D., M.P.H., Cheryl Pegus, M.D., M.P.H.
Disparities in Health Care Utilization and Functional Limitations Among Adults With Serious Psychological Distress, 2006–2014
Psychiatric Services doi: http://dx.doi.org/10.1176/appi.ps.201600260

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