The Affordable Care Act (ACA) requires insurers to offer coverage for behavioral health services in their plans—but a growing shortage of mental health professionals may leave millions without access to those services.
Where the providers are
According to a recent survey by HHS's Health Resources and Services Administration, about 96.5 million Americans resided in areas that lack an adequate number of mental health specialists as of September 2014, up from 91 million in 2012.
Care Transformation Center BlogHow does a social or behavioral health issue impact physical health care?
According to data from Mental Health America, the five states with the best access to mental health care—measured by access to treatment, access to insurance, cost and quality of coverage, and access to special education—are:
Meanwhile, the states with the worst access to mental health services are:
The shortage of mental health providers can be attributed to how long it takes to become a certified behavioral health specialist, as well as low pay and frequent turnover for some positions. In addition, there has been no increase in federally funded resident programs to train doctors, despite provider groups calling for change for more than a decade.
According to the Journal, some initiatives to provide federal payments to incentivize physicians to work in areas with the most severe shortages have succeeded.
How providers are adapting
Expert groups—including the American Psychiatric Association (APA)—say the shortage would most adequately be addressed through a team effort between nurse practitioners (NP), physician assistants (PA), and other providers who can treat behavioral health problems. Debbie Plotnick, senior director of state policy for Mental Health America, says, "If you're starting to feel unwell, you don't go straightaway to an oncologist or a surgeon," adding, "We need to educate the public there are more than just psychiatrists."
Under the model recommended by the APA, physicians would remain at the helm and supervise other medical professionals like NPs and PAs. Sam Muszynski, APA's director of health care systems and financing, says, "The roles are defined. Everyone is treating to outcome and remission," adding, "there are just treatment protocols that need to be followed."
Some local systems are choosing to do more to address the issue. For instance, Philadelphia's behavioral health services department is using a wide variety of mental health providers—including some without formal medical training—such as peer educators who are also users of behavioral health services. So far, the city has trained 643 "peer specialists" to help treat individuals with mental health issues, in some cases using Medicaid dollars.
In addition, advances in technology can help to relieve the shortage, experts say. Robert Bosch Healthcare Systems, for example, created a device that providers can use to keep track of patients with bipolar disorder or depression to ensure they are properly managing their medication or attending behavioral therapy sessions (Radnofsky, Wall Street Journal, 2/16).
The takeaway: Although some national and local efforts are helping address shortages, millions of patients who gain access to mental health coverage through the ACA may struggle to access mental health services.
Odds are, you aren't meeting patients' behavioral health needs
See our study on how hospitals can be proactive at managing behavioral health, and this accompanying video on why that matters so much—not just for patients' mental state, but for their physical health too.