Behavioral health care access remains a challenge

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

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

1. Limited access to in-network providers.
2. Mental health system structural issues.
3. Approval processes and coverage limitations.

Behavioral health issues affect millions of adults in the U.S., but relatively few receive treatment, Locke said. Of the 57.8 million adults with a mental health condition in 2021, about 26.5 million had received treatment in the past year, a Substance Abuse and Mental Health Services Administration survey found. About 2.1 million of the 44 million adults with substance use disorders received treatment at a specialty facility in 2021.

Cost cited as top factor

When those with a mental health condition were asked why they did not get treatment, the top reason given was that they couldn’t afford the treatment. Those with a substance use disorder who didn’t get treatment said their No. 1 reason for not receiving treatment was that they did not perceive they needed it.

Congress took a step toward improving behavioral health care access by establishing the Certified Community Behavioral Health Clinic model, designed to ensure access to coordinated comprehensive behavioral health care, Locke said. CCBHCs are required to serve anyone who requests care for mental health or substance use, regardless of their ability to pay, place of residence, 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, she explained.

The behavioral health care system is also challenged by a workforce shortage, Locke said.

SAMSHA found that about half of the counties in the U.S. did not have an active psychiatrist or addiction medicine specialist in 2020. The Health Resources and Services Administration has projected shortages of psychiatrists and addiction counselors for 2030.

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

1. Low reimbursement rates from payers combined with a 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 keep people in the profession.

Unity Agenda mental health focus

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

1. Strength system capacity.
2. Connect more Americans to care.
3. Create a continuum of support.

SAMHSA’s priorities for 2023-26, she said, are:

1. Preventing substance abuse and overdose. A key activity is supporting naloxone distribution.
2. Enhancing access to suicide prevention and mental health services. A key activity is focusing on expanding culturally competent services for the 988 lifeline, including using American Sign Language, Spanish language services and specialized communication supports for the under-25 LGBTQ+ population.
3. Promoting resilience and emotional health for children, youth and families. A key activity is matching the right child with the right intervention at the right time.
4. Integrating behavioral and physical health care. A key activity is enhancing the knowledge and capacity of the health care workforce.
5. Strengthening the behavioral health workforce. A key activity is expanding the use of paraprofessionals and peers.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].