Only 38% of Americans Get Mental Health Care When They Need It, and For One Simple Reason


One of the biggest untreated problems in the United States affecting everything from social relationships to employment is mental health. Many do not receive the care they need, mostly for financial reasons. Luckily, things may improve in the next few years, as the Affordable Care Act is implemented across America.

Around 25% of adults experience a mental health issue in a given year, yet less than 1 in 3 adults receives services. According to the CDC, around 50% of Americans will experience some mental health issues over their lifetimes. The rate of mental health issues in the U.S. is abnormally high, and lack of treatment options is only making this worse. The estimated impact in terms of loss of productivity in the workplace is around $63 billion. Only a small percentage of these diagnoses consist of severe problems such as schizophrenia, but the impact of other more treatable forms of mental disorders is undeniable.

The Substance Abuse and Mental Health Services Administration recently released the results from its 2011 national survey on mental health. One of the most disturbing results in this survey is that only 38% of individuals with mental health issues have received appropriate services. 

A simple graphic on page 26 of the report outlines the reasons why individuals did not pursue services. The single biggest reason for not receiving services is “Could Not Afford the Cost.” When cost is combined with responses around under-insurance, over 65% cited money-related issues as the primary reason for not pursuing treatment.

Lack of treatment impacts more than just productivity. Many untreated mental health issues lead to an increased likelihood of substance abuse, child abuse, and other domestic problems.  The financial ripple effect is much greater than the loss of individual productivity, resulting in more services being consumed in other programs.

The simple question is, what can be done?

For a very long time, insurance companies have skimped or omitted coverage for mental health services. Most plans pay 50% of the cost of services at best. Given the large number of uninsured Americans, it is easy to see why so many people cite money as the reason they have not pursued services. 

Culturally, the U.S. has a common stigma against people who pursue mental health services. Many people associate mental health services with neurotics like Woody Allen who have spent decades in “analysis” with no outward signs of improvement. The simple fact is that many people experience mental health issues during periods of great stress such as illness, financial worries, job loss, etc. Treatment is often an educational process, helping people to learn coping strategies to reduce their internal stress levels and to respond more appropriately to life’s challenges. The myths around Freudian-style analysis obscure how important timely services can be for many people.

Although the ACA has been arguably the most divisive issue in the Obama presidency, it does offer a ray of hope for improving mental health services in the United States.  On January 1, 2014, all qualified health plans under the ACA will be required to cover mental health services. Not only does the ACA require coverage, it expands services to where they often needed but currently ignored. 

As David Mechanic explains in a 2012 article in the journal Health Affairs:

“It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care.”

While we still have a long way to go to address the unmet needs to mental health services in the U.S., the ACA should put us on track for lasting and meaningful change.