Can We Build an Equitable Mental Health Ecosystem? | Deloitte US has been saved
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By Ali Muckle Egizi, health research leader, and William Eggers, executive director, Center for Government Insights, Deloitte Consulting LLP
September is Suicide Prevention Awareness Month. Some people—due to their race, ethnicity, gender, socioeconomic background, or location—are at higher risk of suicide and mental health issues.1 Our recent report—A human-centered vision for improving the mental health care ecosystem—examines inequities in mental health care, and looks into ways barriers to access and care could be removed.
Consider this: The overall suicide rate among Black Americans is 60% higher than it is for white Americans.2 Black Americans are also 20% more likely to have serious psychological distress than white Americans, according to the National Institute on Minority Health and Health Disparities.3 Navigating the complexities of the mental health ecosystem can be particularly challenging for individuals who are also coping with issues such as housing insecurity or unemployment. In addition, people who regularly transition between group homes, psychiatric wards, emergency rooms, and the street can find it difficult to secure stable support for their mental health.
Inequities in mental health go beyond race, ethnicity, and socioeconomic class. People who live in rural areas tend to have less access to mental health services and are far more likely to die from suicide than are people who live in urban or suburban areas.4 More than 150 million people in the US—most from rural or partially rural communities—live in areas where there is a shortage of mental health professionals, according to the federal Health Resources and Services Administration.5
988, a national mental health crisis line that went into effect on July 16, could make mental health more accessible and equitable to people who live in rural areas or who have difficulty connecting to a mental health professional. More than $430 million in federal funding is being used to scale up existing state-run crisis centers to connect people in need to trained and empathetic health care professionals. The 988 code for the Suicide and Crisis Lifeline program is similar to the 911 nationwide emergency number.6 The program will allow people to connect to a health care professional via phone, text or chat 24/7. Funding will also be used for special services including a network of Spanish speakers. States are responsible for staffing and funding the call centers once federal funds are depleted, according to a press release from the Department of Health and Human Services.
COVID-19 exacerbated mental health challenges
Mental health inequities were exacerbated by the COVID-19 pandemic. In the nearly three years since the virus emerged, many Americans have found it increasingly difficult to access mental health services. Nearly 50 million adults experienced some form of mental illness in 2022, and more than half of them received no treatment for their conditions, according to our report. Moreover, the percentage of adults who reported symptoms of anxiety or depressive disorders nearly tripled from 11% before the start of the pandemic, to more than 30% by June 2022, according to the Kaiser Family Foundation. But mental health issues were already on the rise before the pandemic began. The worldwide incidence of mental illness and substance abuse disorders jumped 13% between 2007 and 2017, according to the World Health Organization (WHO).
Few therapists accept health insurance
The cost of mental health visits, combined with generally low reimbursement rates from payers, is one theme that emerged during our research. About one-third of therapists do not take health insurance due to low reimbursement rates, paperwork, and claim denials.7 The mental health professionals who do accept insurance are often in short supply.8 In addition, mental health issues can be more difficult to quantify than physical health conditions. For example, it is easy to measure a patient’s glucose levels or blood pressure and prescribe effective therapies. But assessing and treating mental health can be less straightforward.9 Nearly 20% of medical-necessity-claim denials were for behavioral health services among health plans sold through HealthCare.gov, the federally operated health insurance exchange.10
Untreated mental illness can lead to diminished productivity, higher unemployment, foregone tax revenue, more welfare expenditures, and an increase in physical ailments such as cardiovascular and metabolic disease, according to our research. For every $1 invested in scaled-up treatment for depression and anxiety, there is typically a $4 return in better health and productivity.11 Despite this return on investment and new models of care, people who need mental health care are often unable to access it. By understanding the challenges some people encounter when dealing with mental health issues, we are hopeful that policymakers at the federal, state, and local levels will push to create a more equitable mental health ecosystem that makes it easier for everyone to access the services they need.
If you or someone you know is in crisis, you have options. Please call or text 988 for the National Suicide Prevention Lifeline; call 911; or visit your nearest emergency room.
1 Five key findings on mental health and substance use disorders by race/ethnicity, September 22, 2022
2 US Department of Health and Human Services Office of Minority Health, Mental and Behavioral Health—African Americans, 2022
3 US Department of Health and Human Services Office of Minority Health, Mental and Behavioral Health-African Americans, 2022
4 Suicide in rural America, US Centers for Disease Control and Prevention
5 Health workforce shortage areas, Health Resources & Services Administration, September 24, 2022
6 transition to 988 Suicide & Crisis Lifeline, HHS press release, July 15
7 Therapists who don’t accept insurance, Psychology.org, August 18, 2022
8 Why it’s so hard to find a therapist who takes insurance, Wall Street Journal, October 5, 2021
9 Challenges and opportunities in measuring the quality of mental health care, The Canadian Journal of Psychiatry
11 Mental health matters, The Lancet Global Health, November 2020
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Bill is the executive director of Deloitte Services LP’s Center for Government Insights where he is responsible for the firm’s public sector thought leadership. His latest book is Delivering on Digital: The Innovators and Technologies that are Transforming Government (Deloitte Insights, 2016). His eight other books include The Solution Revolution: How Government, Business, and Social Enterprises are Teaming up to Solve Society’s Biggest Problems (Harvard Business Review Press 2013). The book, which The Wall Street Journal calls “pulsating with new ideas about civic and business and philanthropic engagement,” was named to ten best books of the year lists. His other books include The Washington Post best seller If We Can Put a Man on the Moon: Getting Big Things Done in Government (Harvard Business Press, 2009), Governing by Network (Brookings, 2004), and The Public Innovator’s Playbook (Deloitte Research 2009). He coined the term Government 2.0 in a book by the same name. His commentary has appeared in dozens of major media outlets including the New York Times, Wall Street Journal, and the Washington Post.