Access and Coverage for Mental Health Care: Findings from the 2022 KFF Women’s Health Survey

James Eaton

Essential Takeaways

  • A considerably better share of ladies (50%) than adult men (35%) believed they needed mental health companies in the past two yrs. Among the these who imagined they wanted psychological health care, about 6 in ten women of all ages and males sought treatment in the past two several years.
  • Practically two-thirds of youthful females ages 18-25 report needing mental wellbeing care in the past two several years when compared to one particular-3rd of ladies ages 50-64.
  • Among all women of all ages ages 18-64 who thought they essential psychological overall health providers in the past two several years, just half experimented with and were being capable to get an appointment for mental well being care, 10% experimented with but were not able to get an appointment, and 40% did not search for treatment.
  • Practically fifty percent of gals who needed psychological health products and services and tried out to get care were being in a position to get an appointment inside of a month, but much more than just one-3rd of gals had to wait around much more than a month. Amid these who could not get an appointment, gals cite minimal company availability and price tag as the principal motives they were being unable to access psychological health and fitness care.
  • Two in 10 privately insured girls with a mental overall health appointment in the past two decades say their provider did not accept their insurance policies.
  • Sixty percent of women experienced a telemedicine/telehealth take a look at in the previous two many years. Psychological health and fitness care was the 3rd most prevalent reason gals cited for accessing telehealth/telemedicine companies, with 17% expressing it was the principal intent of their most latest telemedicine pay a visit to. The bulk report that the top quality of their telehealth go to was the identical as an in-person check out.

Introduction

Mental well being has emerged as a promptly developing issue in current a long time, with 90% of Americans expressing there is a mental well being disaster in a current KFF-CNN poll. Gals experience several psychological health ailments far more usually than guys, and some also experience mental overall health issues that are distinctive to women of all ages, these as perinatal melancholy and premenstrual dysphoric issues that might occur when hormone levels modify. Knowledge from the Countrywide Centre for Overall health Studies exhibit that across all age teams, gals had been pretty much 2 times as probable to have melancholy and anxiousness than gentlemen. The COVID-19 pandemic, the opioid epidemic, and racism are between usually cited stressors that have exacerbated extensive-standing psychological wellness problems and prompted developing need for mental wellness expert services in the past two yrs, notably between ladies.

This transient provides new data from the 2022 KFF Women’s Wellbeing Study (WHS), a nationally consultant study of 5,145 ladies and 1,225 adult men ages 18-64 conducted mostly on the web from May well 10, 2022, to June 7, 2022. In addition to several topics similar to reproductive health and nicely-remaining, the survey requested respondents about their ordeals accessing psychological health companies in the earlier two a long time. This concern transient presents KFF WHS knowledge on psychological health and fitness solutions access among the self-discovered females and adult males ages 18-64, and it also normally takes a closer look at mental wellness coverage among females. Individuals of all genders, which include non-binary people today, ended up requested these questions nevertheless, there are inadequate knowledge to report on non-cisgendered persons. See the Methodology section for details.

Utilization of Mental Wellness Companies

Gender Dissimilarities

50 % of females ages 18-64 (50%) imagined they desired mental well being providers in the past two a long time (Figure 1) and a appreciably scaled-down share of adult men report they essential mental health care (35%).  Studies have prolonged documented gender disparities in the costs and varieties of psychological overall health disorders. Among the individuals who considered they necessary care, nonetheless, comparable rates of gals and adult males report looking for treatment. Sixty % of ladies tried out to make an appointment for mental wellness in contrast to 56% of males.

Want and Care Looking for

Just about two thirds (64%) of women ages 18-25 considered they desired mental well being providers at some position in the earlier two decades compared to just 35% of gals ages 50-64 (Figure 2). Past results from the 2020 KFF WHS exposed that more than 50 percent of gals (51%) stated that get worried or anxiety related to the coronavirus experienced influenced their psychological well being. Other scientific tests show that younger older people, particularly girls, seasoned high incidence of despair and loneliness all through the early levels of the pandemic.

More than 50 percent of females with very low incomes (< 200% of the federal poverty level (FPL)) (55%) and women with Medicaid coverage (58%) thought they needed mental health care in the past two years compared to less than half (47%) of women with higher incomes (≥ 200% FPL) and those with private insurance (includes employer-sponsored insurance and individually purchased insurance) (47%). The FPL in 2022 for an individual is $13,590 (Figure 2).

Among those who thought they needed mental health care, larger shares of women ages 26-35 (63%) and women ages 36-49 (64%) sought care compared to 55% of women ages 50-64. Larger shares of women enrolled in Medicaid (67%) sought mental health services compared to women who have private insurance (58%) and women who are uninsured (50%) (Figure 3).

A significantly lower share of Asian/Pacific Islander women (40%) say they needed mental health services at some point in the past two years than their White counterparts (50%). Although not statistically significant, smaller shares of Asian/Pacific Islander women report seeking care compared to White women (50% vs. 62%). While the pandemic fueled violence against Asians and subsequently worsened anxiety and mental health for many, studies have shown that Asians reported greater cultural barriers to help-seeking such as family stigma and concerns about “losing face.” Cultural barriers may influence perceived need of care in addition to help-seeking behaviors.

Although the self-reported need for mental health care did not differ between Hispanic and White women (both 50%), smaller shares of Hispanic women (56%) sought care compared to White women (62%). Despite high rates of depression among Hispanic women, studies have shown that stigma and perceived discrimination in health care settings can contribute to underutilization of mental health services within Hispanic communities. Hispanic women also have the highest uninsured rate, which may limit their access to care.

Among the 50% of women who thought they needed mental health services, half (50%) were able to get an appointment, while another 40% did not try to get mental health services (Figure 4). One in ten (10%) who tried to get care were unable to make an appointment for mental health services. This suggests that the other half of women who report needing care may have unmet mental health needs.

Among all women who thought they needed mental health care and tried to get it in the past two years, nearly half (47%) had to wait less than a month for an appointment (Figure 5). One-quarter (24%) had to wait one to two months, and 13% had to wait more than two months to get care. The remaining 16% of those who sought mental health care could not get an appointment.

Among the 16% of women who needed care, sought care, and were unable to get an appointment for mental health services, the main reasons were limited provider availability and cost barriers. One-third of women who could not get an appointment say the main reasons were that they could not find a provider that was accepting new patients (33%) or that they could not afford the cost of mental health services (33%). Eight percent could not get an appointment in a reasonable amount of time and six percent say they could not find a provider nearby. Another 6% say they could not get an appointment for another reason, such as not wanting to go in-person due to COVID-19.

Our findings on provider availability are consistent with other studies on mental health access. A report from the U.S. Government Accountability Office found that many consumers with health insurance faced challenges finding in-network care. The country also faces a workforce shortage of behavioral health professionals in addition to other challenges with health care infrastructure that exacerbates issues with accessibility.

Figure 5: Women Were Unable to Access Mental Health Care Largely Due to Cost Barriers and Limited Provider Availability

Cost and Coverage for Mental Health Services

Among those who sought care but could not get an appointment, one-third (33%) say the main reason was that they could not afford it (Figure 5). Cost remains a barrier to mental health care access for some people with insurance and especially for those who lack coverage. Significantly larger shares of women who are uninsured (60%) say they could not get an appointment due to affordability reasons, compared to those who have health insurance either through private plans (33%) or Medicaid (30%) (Figure 6). There were no significant differences between women who have private insurance and women covered by Medicaid.

These findings on cost barriers are consistent with current literature, which has found that along with provider availability, affordability is one of the most prevalent barriers to mental health care.

While federal laws require special insurance protections such as parity for mental health care, gaps in coverage remain. All state Medicaid programs provide coverage for mental health services, and the Affordable Care Act (ACA) requires most private insurers to cover mental health care. However, the scope of coverage varies, provider networks are limited in many plans, and mental health providers may not accept all insurance plans. Some mental health practitioners do not accept insurance of any kind.

While most privately insured women who received mental health services in the past two years say their provider accepted their insurance for their most recent mental health visit (81%), two in ten (19%) say their provider did not. Among privately insured women who said their provider accepted their insurance, more than half report having out-of-pocket expenses for their most recent mental health visit. More than one-third (36%) say their insurance covered the full cost and 52% say their insurance covered some of the cost. Three percent say their insurance did not cover any of the cost. (Figure 7).

Figure 7: Two in Ten Privately Insured Women Who Got Mental Health Care Say Their Provider Did Not Accept Their Insurance

The Affordable Care Act requires that enrollees in most private health insurance plans have the right to appeal denied claims, though some evidence suggests that many are unfamiliar with appeals processes or are unaware of this protection. Among privately insured women whose insurance was not accepted by their mental health provider, 27% filed a claim with the health insurance plan to try to get reimbursed for some or all the cost (data not shown).

Telehealth

Social distancing during the pandemic contributed to a sharp increase in the provision of telehealth services, widening the access of counseling, therapy, prescribing, and other services via remote methods such as video and telephone. The rapid expansion of telemedicine/telehealth over the course of the COVID-19 pandemic has broadened access to health care for many, including access to mental health services. Mental health services provided via telehealth include speaking to a mental health provider over telephone or video, or through online apps such as Talkspace.

Sixty percent of women ages 18-64 had a telemedicine/telehealth visit in the past two years. Among these women, 17% say the primary purpose of their most recent visit was for mental health services (Figure 8). Accessing mental health care services was the third most common reason for telehealth visits, following annual check-ups (18%) and visits for minor illness or injury (18%). Three in ten women ages 18-25 (29%) say their most recent telehealth visit was for mental health services compared to 20% of women ages 26 to 35, 18% of women ages 36 to 49, and 10% of women ages 50 to 64 and older. A larger share of White women (21%) obtained mental health services at their most recent telehealth visit than Black women (13%), Hispanic women (14%), and Asian/Pacific Islander women (7%).

A larger share of women with Medicaid coverage (22%) report that their most recent telemedicine or telehealth visit was for mental health services than women who are privately insured (15%).

A similar share of women living in rural (23%) and urban/suburban (17%) areas report that the primary purpose of their most recent telehealth or telemedicine visit was for mental health services.

The majority (69%) of women who had a telehealth or telemedicine visit in the past two years for mental health care say the quality of care they received at their most recent visit was the same as an in-person visit for this type of care (Figure 9). One-in-five (19%) report receiving better quality of care during their telehealth visit, while 12% report experiencing worse quality than an in-person visit. These findings suggest the quality of mental health care is typically not diminished when accessing care via telehealth.

Conclusion

The demand for mental health care continues to surge as wait lists for professional help grow. Recent reports reveal that mental health providers across the nation are facing an overwhelming demand for services, leaving many individuals without care. Our survey finds that among the half of women who report that they thought they needed mental health services in the past two years, only half got an appointment for care. Unmet mental health needs are known to affect the overall well-being and productivity of individuals, families, and society, and studies have consistently shown that women are disproportionately affected by these unmet needs. Data from the 2022 KFF WHS underscore that addressing issues with provider availability and cost could improve access to mental health care for some. Our findings suggest that affordability barriers are a substantial obstacle for uninsured women.

In response to the COVID-19 pandemic and other changes in the health policy environment, larger shares of employers began expanding coverage of mental health services by including more providers for in-person and telehealth care. Telehealth and telemedicine services have been recognized as an evolving strategy to increase access to care and address health needs, including care for mental health. We found that most women who received mental health services via telehealth say the quality of care they received was the same as in-person care. Telehealth has and likely will continue to play a role in addressing mental health access concerns for women.

Despite federal and state laws intended to expand and strengthen coverage for mental health care, gaps in coverage and problems with affordability continue to hinder access to mental health services even for those with private insurance and Medicaid. Our survey finds that in addition to challenges obtaining services, many women who have insurance faced at least some out-of-pocket costs for their visit. The findings from the 2022 KFF WHS suggest that future policies affecting telehealth, provider availability, health insurance coverage, and affordability will play a significant role in addressing the demand for mental health care.

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