Which Barriers Block Mental Healthcare Access for Young Adults?

More and more young adults are citing cost and stigma as key mental healthcare access barriers, according to the latest in JAMA Network Open.

The study, published as a research note, found that the proportion of young adults ages 18 to 25 saying cost and fear of being committed or having to take medicine for mental health diagnoses grew between 2011 and 2019. These findings, particularly the ones about healthcare cost barriers, indicate a need for better health coverage policy decisions, the researchers wrote.

Mental health issues are common among all adults in the US but are most prominent in the young adult category (ages 18 to 25). Nevertheless, access to mental healthcare leaves much to be desired, the researchers from the City University of New York said.

“Untreated depression increases young adults’ risk for substance abuse, risky sexual behaviors, unemployment, and suicide,” the research team explained.

The researchers scanned data from the 2011 through 2019 National Survey for Drug Use and Health to better understand civilian and noninstitutionalized young adults ages 18 to 25. Particularly, the researchers looked at responses for nearly 21,000 young adults with a major depressive episode within the previous 12 months of completing the survey to assess mental healthcare access.

Just about half of those respondents (11,186) said they did not access mental healthcare a year after experiencing a major depressive episode, with most of those patients citing cost of care as a leading barrier. These were patients who needed that mental health attention, the survey data indicated, with more than half saying they had functional impairment as a result of the major depressive episode.

Nevertheless, nearly 55 percent said in 2019 mental healthcare costs were too high, prohibiting them from access. This represents the peak of cost-related healthcare access problems, the researchers reported; the number of patients reporting out-of-pocket cost issues and limited healthcare coverage as care access barriers grew over the study period between 2011 and 2019.

Healthcare affordability problems were most salient among American Indian/Alaska Native (AI/AN) respondents, who were more likely than other racial groups to report limited insurance coverage as a care access barrier.

These findings about out-of-pocket healthcare costs are important because they represent a somewhat objective measure of healthcare barriers. Unlike stigma, healthcare affordability doesn’t have to be self-reported and there is no room for interpretation; a patient can either afford mental healthcare or they cannot and they have insurance coverage or not.

That means understanding how affordability affects mental healthcare access can provide tangible guidance for healthcare policymaking, the researchers said. Particularly, lawmakers can look at Medicaid eligibility, the team advised.

“Since its implementation in 2014, the Medicaid expansion has reduced the rate of uninsured individuals and improved access to care for adults with depression,” the researchers wrote in the study’s discussion. “Immediate policy actions are needed, therefore, to close the Medicaid coverage gap, especially for Native American individuals.”

Respondents also reported stigma or social desirability issues. In 2019, about a quarter of young adults needing mental health said they didn’t access it because they were worried they’d be institutionalized or have to take some form of antidepressant or medication.

Over the course of the study, concerns about stigma and social acceptance kept arising, the study continued. Patients repeatedly noted fears that counseling or therapy would have a negative impact on their jobs and concerns about confidentiality. Hispanic patients and male patients were more likely than others to say they were worried about someone finding out they were in therapy and about the opinions of their communities.

Although the researchers did not offer specific policy proposals, they did note that these findings suggest a need for more work on destigmatization. Particularly, those efforts should be tailored to certain demographics.

Finally, the researchers uncovered key trends regarding patient navigation. Particularly, 37 percent of patients said they did not know where to go for mental healthcare in 2019, with the proportion of young adults saying as much growing across the 2011-2019 study period. Patient navigation was particularly pressing for Hispanic and Asian patients compared to white patients.

“More outreach campaigns are also warranted to increase young adults’ awareness of local mental health services, particularly among Hispanic and Asian communities,” the researchers recommended.

Better patient outreach, navigation, and community-based mental health resources could have the dual benefit of destigmatizing mental healthcare. By normalizing mental healthcare access within communities, patients may be more compelled to access the care they need.