Survey: Access to mental health, substance use disorder care is a challenge for Massachusetts adults

Data from the 2018 Massachusetts Health Reform Survey showed that 56.8 percent of adults ages 19 to 64 who sought help for mental health or substance abuse disorders experienced difficulties obtaining care.

The problems included finding a provider who would see them at all or getting an appointment in a timely manner when it was needed.

As a result, more than one-third of those adults went without help and 12.7 percent visited an emergency department to address those issues.

The Blue Cross Blue Shield Foundation and Urban Institute collected the information using data from a random telephone survey involving 2,201 respondents representing a range of race/ethnicity, income levels, and geographic distribution.

The majority of people seeking care for themselves were lower income and reported that limits to their work or activity levels were because of mental health or substance abuse issues.

One of the key takeaways from the study is that having health insurance doesn’t guarantee access to health care generally or to mental health or substance use specifically, said Kaitlyn Kenney Walsh, Ph.D., senior director for policy and research at BCBS Foundation.

Among insured adults, 46 percent said they had difficulty obtaining health care in general over the past year and more than a third said they went without care.

For insured adults seeking mental health or substance use disorder help, 55 percent said they had trouble getting services and a third went without as a result.

“Insurance coverage doesn’t guarantee affordable health care,” Kenney Walsh noted. Half the insured people who sought mental health assistance reported a problem with affordability.

The survey also showed that the challenge accessing health care services disproportionately impacts low-income and moderate-income adults.

More than 40 percent of low-income adults (138 percent of the federal poverty level or less/$16,753 for an individual in 2018) and moderate income (between 138-300 percent of the federal poverty level/$36,420) reported that they did not receive the help they needed.

That figure compares to less than a third of high income insured adults.

The next step, according to Kenney Walsh, is that the Foundation recently released a report called “Ready for Reform: Behavioral Health Care in Massachusetts.” The report serves as a call to action to begin a “systematic approach” to reforming the behavioral health care system.

Successful reform cannot occur without input from stakeholders including consumers, consumer groups, insurers, employers, providers and others, she said.

“We believe psychologists are an important stakeholder group that should be encouraged to participate in a reform strategy, helping to craft solutions to some of the key access issues,” identified in both reports, Kenney Walsh said.

Another way psychologists can participate is by identifying and supporting policies and programs that would help with retention, onboarding and training of new providers, she added.

When asked how to avoid these studies getting put on a shelf and forgotten, Kenney Walsh replied that the Foundation tries to develop a policy and research agenda that is responsive to people who can make a difference–stakeholders, policymakers and their staff.

“Release of the survey results and the ability to track changes over time will serve as a continual reminder of the importance of this issue for policymakers and as a measure of how we’re faring collectively,” she said.

The BCBS of Massachusetts Foundation began conducting the Health Reform Survey in the fall of 2006 to support evaluation of the state’s health care reform law.

It has monitored key measures pertaining to health insurance coverage, health care access, and affordability among adults 19 to 64 years old.

The 2018 survey included questions regarding behavioral health services for the first time. Future surveys will have specific questions on access to mental health care and substance use disorder services in order to track progress on access to care, she said.

Kenney Walsh added that she was not surprised by the survey data because the results about challenges have been shared and reported anecdotally for some time.

“Unfortunately, the survey corroborated our expectations,” she said. “There’s much work to be done to improve the behavioral health care system in Massachusetts.”

She added that she is confident the state “with its political will, expertise and leadership,” can bring about change.