That is the key takeaway from a recent JAMA Viewpoint by Carlo, Barnett and Frank (2020). While there has been some progress, there are still tremendous gaps that need to be addressed.
For patients with schizophrenia, bipolar disorder, or other more serious mental health conditions, less than two-thirds received care for their illness, according to data from the Substance Abuse and Mental Health Services Administration’s 2018 National Survey on Drug Use and Health, which included more than 65 000 respondents.1 Perhaps of most concern, in a time of tens of thousands of annual overdose deaths from the opioid epidemic, the same study found that only 1 in 5 people with an opioid use disorder obtained any treatment
Why are we failing? Certainly mental illness has a stigma. Patient cost sharing certainly deters other patients. Provider reimbursement also matters. For instance, data from the 2009-2010 National Ambulatory Medical Care Survey found that:
…nearly half of psychiatrists surveyed did not accept network commercial insurance payment or Medicare, and more than half did not accept Medicaid. Psychiatrists have one of the lowest Medicaid participation rates among medical specialists.
Why is commercial insurance coverage of mental health and substance abuse poor? Simple, adverse selection. Providing generous coverage for serious mental health and substance abuse care is likely to attract high-cost individuals, something most insurers try to avoid.
However, legislation such as the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 as well as the Patient Protection and Affordable Care Act (ACA) has helped improve conditions. Mental health parity is a simple concept in theory, but may be difficult to define quantitatively. Nevertheless, there has been some progress, although much more needs to be done.