Uninsured Adults Less Likely to Access Mental Healthcare Services

Uninsured adults with moderate to severe symptoms of anxiety or depression were less likely to receive mental healthcare services compared to adults with healthcare coverage, according to a Kaiser Family Foundation (KFF) issue brief.

The COVID-19 pandemic has exacerbated the country’s mental health crisis and increased barriers to accessing care. But Americans have been living with unmet mental health needs since before the pandemic hit.

KFF researchers gathered data from the 2019 National Health Interview Survey to understand how mental healthcare utilization varied by demographics and health insurance coverage.

Before the pandemic, 23 percent of adults reported having symptoms of anxiety or depression. Nearly 55 million adults reported at least mild symptoms, while 9.5 million reported experiencing severe symptoms. Around a third of adults with severe symptoms (3.1 million) did not receive treatment, including counseling or prescription medication.

Almost 22 million adults reported having moderate to severe symptoms of anxiety or depression, but 8.5 million of these individuals did not receive treatment.

Around two in ten adults said they skipped or delayed therapy due to the cost. Past data from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 25 percent of adults with mental illness and unmet healthcare needs did not know where to seek care, preventing them from receiving treatment.

Behavioral and mental healthcare provider shortages and low insurance acceptance rates may also be driving factors behind the lack of treatment utilization, the brief suggested.

Medicaid was the most common insurance provider for adults who reported moderate to severe anxiety or depression symptoms, with 19 percent of individuals enrolled in the public program. Ten percent of adults were uninsured, nine percent received coverage through Medicare, eight percent received group coverage, and six percent were enrolled in an employer-sponsored health plan.

Uninsured adults with moderate to severe symptoms were more likely to go without mental healthcare services compared to insured adults, the brief found. Almost two-thirds (62 percent) of uninsured adults reported not receiving treatment. Meanwhile, only 35 percent of Medicaid beneficiaries and 34 percent of Medicare beneficiaries did not receive care.

Additionally, 37 percent of adults with employer-sponsored coverage and 45 percent of adults with nongroup coverage went without treatment.

“Narrow mental health networks in private insurance plans, including nongroup plans, may be linked to access issues,” the brief stated. “Prior to the pandemic, individuals enrolled in nongroup plans commonly reported delayed or forgone care due to cost. Many employers have indicated that they have narrower provider networks for mental health services than other healthcare.”

Among insured adults who experienced moderate to severe symptoms of anxiety or depression, going without treatment was most common for adults who did not have a usual source of outpatient care, according to the brief.

More than half (57 percent) of insured adults without a usual source of care did not receive mental health treatment compared to 34 percent of insured adults with a usual source of care. Having a usual source of care may allow individuals to receive mental healthcare services directly from the provider or through referrals to external mental health specialists.

However, researchers noted that having a usual source of care does not always guarantee individuals will be able to access mental healthcare services. A lack of mental health screenings, high costs for mental healthcare treatments, and coverage limitations may still inhibit access for insured adults with a usual source of care.

For example, data from the Employee Benefit Research Institute found that employer-sponsored high deductible health plans led to higher employee healthcare spending and lower mental healthcare utilization.

Additionally, an October 2021 study revealed that privately insured individuals found their health plan mental health network to be less adequate than their medical care network.

The COVID-19 pandemic highlighted the need for better access to mental healthcare services. Policymakers enacted regulations that made it easier for individuals to access treatment, such as expanding telehealth coverage for mental healthcare.

Certain pandemic policies like the American Rescue Plan Act also increased access to healthcare coverage for uninsured individuals by introducing premium subsidies to make coverage more affordable.