Even with insurance, it’s a struggle to access mental health care

Washington, D.C. — Workers with mental health conditions are twice as likely as those without to report unmet mental health care needs, a stark reminder that even those with insurance struggle to get effective mental health treatment.

The consumer survey conducted by the Employee Benefit Research Institute (EBRI) and released today by the Path Forward Coalition captured the experiences of people with employer-based insurance, relying on survey data from 3,100 workers across the United States. The workers were between the ages of 20 and 74 and covered with an employer-based health plan from their own employer or a spouse’s or parent’s employer. About 165 million Americans receive insurance through an employer, either their own or a family member’s. (Survey report link - https://www.ebri.org/employeespathforwardreport.)

Key findings on access to mental health care:

• More than one in four workers (27%) reported they or someone on their health plan has a mental health condition. These individuals were more likely to be between 25 and 54 years old, more often married with children, and more often employed at smaller firms.

• People are struggling to get care – especially mental health care. Respondents reporting a mental health condition were twice as likely as those reporting no mental health condition to be unable to get medical care, tests, or treatment they or a doctor believed necessary over the past six months. One in three respondents reporting a mental health condition said they struggle to get mental health or behavioral health care (33%) and prescriptions (32%). That’s more than twice the rate of those who did not report mental health conditions.  A doctor’s refusal to accept their insurance was nearly twice as likely to be cited as the main barrier to care by respondents with a mental health condition compared with those without. Lack of time off of work and childcare were also major barriers.

• Emergency room use is high: Nearly two-thirds (62%) of respondents with a mental health condition visited the ER in the past six months. They were 50% more likely than those who did not report a mental health condition to use emergency care, twice as likely to visit the emergency department three times, and four times as likely to visit four times in a six-month period.

• Anxiety, depression, ADHD are most common: Anxiety (17%), depression, (11%) and attention-deficit/hyperactivity disorder (ADHD) (8%) were the most frequently reported conditions.

Today’s snapshot of worker experiences backs widely reported population surveys by the National Alliance on Mental Illness (NAMI) showing nearly half of Americans with mental health fail to get the care they need.

The data show individuals reporting mental health conditions indicated proactive health behaviors, like comparing prices, researching clinician quality, and talking about treatment and prescription options with providers. That suggests problems getting mental health care aren’t due to lack of trying.

“U.S. workers know this already, and the survey brings it home: even with insurance from an employer, getting mental health care is much too hard,” said Anna Bobb, the executive director of the Path Forward Coalition. “We need to make preventative care available early for mental health conditions, just like we do for other common chronic diseases. The ER shouldn’t be frontline treatment for mental health any more than it should be frontline treatment for heart disease.”

Information for this report was collected from a 15-minute online survey of 3,103 workers conducted in March and April 2025.

“By surveying the U.S. workforce, we are taking important steps to go in-depth and find out about the health care benefit experience of workers as it relates to mental health,” said Paul Fronstin, Ph.D., the director of health benefits research at EBRI. “It will also be important to hear the employer’s perspective.”