Transcript for: Demand For Mental Health Care Has Grown, But Access May
Lag Even For Those With Coverage 

Description:  An estimated 21% of adults in the U.S. have mental health
or serious mental health conditions. While many patients have health
care insurance coverage or benefits that include mental health services,
they could still face challenges accessing and paying for these
treatments. We’ll find out more from GAO’s John Dicken. 

Related GAO Work: GAO-22-104597, Mental Health Care: Access Challenges
for Covered Consumers and Relevant Federal Efforts

Released: March 2022

[John Dicken:] Even though most Americans do have health coverage,
coverage does not guarantee access to mental health services.

[Holly Hobbs:] Hi and welcome to GAO’s Watchdog Report--your source for
news and information from the U.S. Government Accountability Office. I'm
your host Holly Hobbs. An estimated 21% of adults in the U.S. have
mental health or serious mental health conditions. This number may have
increased because of the pandemic, as more people experience stress and
anxiety. Many patients have health care insurance coverage or benefits
that include mental health services, but they could still face
challenges accessing and paying for these treatments. Today, we'll learn
more from John Dicken, an expert on health care policy and a director in
our Health Care team. Thanks for joining us. 

[John Dicken:] Thank you. 

[Holly Hobbs:] So John, let's start with how has the pandemic impacted
mental health care? 

[John Dicken:] Yeah, the pandemic and kind of the related economic
crisis have affected the availability of mental health care in several
ways. One is that it's really intensified concerns that more people are
being affected by mental health conditions, and people with underlying
mental health conditions may be having increased severity of those
conditions. There's also increased challenges for the availability of
those services. For some periods of the pandemic, in-person treatment
was very limited or unavailable. And economic stresses may have also
stressed workforce shortages that have existed in having mental health
care providers and staff. There has been one silver lining in that there
has been increased use of telehealth services for mental health, but the
availability of those services may be uneven, especially in areas that
may not have broadband internet services. And only certain types of
services can effectively be delivered by telehealth. 

[Holly Hobbs:] And some of these access issues pre-date the pandemic.
One of the questions we had was, if your health care plan covers mental
health treatment, why would someone still struggle to access these
services? 

[John Dicken:] Right. So while most Americans do have health coverage
and that often includes mental health coverage, there are often still
challenges and that coverage doesn't guarantee access. So people may
have difficulty finding mental health care providers that are in their
plans network, or they may find that those providers are not accepting
new patients or have long wait times. It could also be that there will
be plan approval requirements or disagreements on what the appropriate
level of care would be. And so the plan may have different standards of
care from what a mental health provider might recommend. And some of the
plans also just have coverage limitations. They may not cover certain
types of health services or mental health providers. 

[Holly Hobbs:] What impact does that have on patients? 

[John Dicken:] Yeah, it could result in a number of things for patients.
It could be a delay in being able to receive timely care. They may need
to go to providers that are further away, and not near home and the
supports they have in their community or with their family or friends.
And if they need to go to providers that are not in a plan's network,
then they may have higher out-of-pocket costs or need to pay the full
costs.

[Holly Hobbs:] It sounds like coverage for mental health services is
more restrictive than for other medical services.

[John Dicken:] Yes, we did hear from some stakeholders that mental
health coverage does sometimes seem to be more restrictive than other
medical services. Federal law requires that there be parity if mental
health services are provided. But it's often very challenging to
identify if there is that parity. So we heard that some health systems
thought Medicaid was less likely to grant prior approvals for
hospitalizations for mental health care than for other medical and
surgical hospital stays. And we heard from one insurance regulator that
said the plan’s denial rate for inpatient care were somewhat higher than
for mental health services compared to medical/surgical. 

[Holly Hobbs:] And what's the federal role in this? How is the federal
government involved?

[John Dicken:] Yeah, there's several very important federal roles for
mental health care services. One is the federal government is a major
payer of health care services, particularly through Medicaid and
Medicare, both of which cover many mental health services. But even
beyond the Medicaid, Medicare and other federal programs, HHS and the
Department of Labor have responsibility for overseeing federal
requirements for mental health parity and addiction equity in most
employer-sponsored health plans. And the third role is that HHS, through
various agencies, will provide grants for the mental health workforce,
for training mental health workers and expanding community treatment
options. So important federal roles in providing mental health services 

{MUSIC}

[Holly Hobbs:] So John just told us that, in some cases, coverage for
mental health care services may be more limited than other health care
treatments, which could also limit patients’ access to this care. And
that the federal government plays an important role in making sure there
is parity (or similarities) between mental health and other health care
coverage. So, John, given the increasing number of people with mental
health conditions and the problems accessing treatments, what is the
federal government doing about it? 

[John Dicken:] We did identify a number of federal efforts that are
trying to address at least some of the challenges experienced by
consumers. One example is HHS is taking steps to ensure that consumers
can access mental health providers offered in their plan by enforcing
requirements for health plans to update and maintain their provider
directories. Other HHS efforts are offering funding to increase the
mental health workforce and increase access to community-based mental
health care. And the Department of Labor and HHS, with new congressional
authority, have recently enhanced their oversight of mental health
parity requirements and ensuring that plans are meeting the requirements
for that.

[Holly Hobbs:] And last question, what's the bottom line of this report? 

[John Dicken:] The bottom line really is that even though most Americans
do have health coverage through either a public health plan or private
insurance, coverage does not guarantee access to mental health services.
Even those with health coverage for mental health can still face
challenges accessing appropriate and timely mental health care, may have
trouble finding in network providers that meet their needs or face other
coverage limitations or a high out-pocket cost.

[Holly Hobbs:] That was John Dicken talking about GAO’s recent review of
access to mental health services. Thanks for your time, John. 

[John Dicken:] Thanks so much. 

[Holly Hobbs:] And thank you for listening to the Watchdog Report. To
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