Barriers to Care are Universal

All U.S. adults who needed care cite difficulties getting it, including those who actually got care. The primary barriers to access for those with unmet needs for mental health or substance use challenges over the past 12 months include:

·        Cost-related issues (no insurance, out-of-pocket costs) prevented 37% from getting mental health care and 31% from receiving substance use care.

·        Inability to find a conveniently located provider prevented 28% from getting mental health care and 22% from getting substance use care. In some rural areas, providers may be hours away.

·        Inability to find a provider who offers a visit format people feel comfortable with (e.g., in-person, telehealth) prevented 25% from getting mental health care and 31% from receiving substance use care.

·        Inability to get an appointment immediately when they needed care prevented 21% from receiving mental health care and 28% from receiving substance use care. Wait times can range from weeks to months in some areas.

Those who did receive mental health or substance use care over the past 12 months also cite difficulties in getting that care:

·        81% of U.S. adults who received substance use care had trouble getting care.

·        67% of U.S. adults who received mental health care experienced difficulties getting care.

The survey also found that many U.S. adults, overall, believe insurance-related issues complicate access. Nearly 3 in 5 U.S. adults believe it is easier (59%) and faster (59%) to get mental health or substance use care if you pay out-of-pocket versus using insurance.In addition, 71% of U.S. adults would be more likely to get mental health or substance use care if they could receive it through their primary care doctor, if they needed it, and 67% think it’s harder to find a mental health care provider than it is to find a physical health care provider.

Peoples’ Lives are Impacted by Unmet Needs

Those with unmet mental health and substance use care needs say not receiving care had an impact on their lives. Among those who did not receive needed mental health care:

·        50% reported personal relationship issues as a result of not getting care.

·        45% reported work issues.

·        44% reported a decline in mental wellbeing.

Among those who did not receive needed substance use care:

·        49% reported work issues as a result of not getting care.

·        43% reported personal relationship issues.

·        37% reported a decline in mental wellbeing.

When statistics are this daunting, it’s hard for many organizations and especially individuals to carve out a piece that they can be assured is making a difference to the whole. Where do we start?

Who understands the problem? Who needs to be educated? Who must be educated to the problem at an administrative level to articulate the problem, define solutions, and put a dollar amount to what it will take to fix it?

Let’s look at this from two directions. What needs to take place at a legislative or administrative level, and, what need to take place at the front lines.

If I am needing help, I may have needed it for some time, however the stigma attached to mental health and substance use (which some substances are still illegal) may have prevented me from seeking help.

Now I’m ready to seek help, but not sure where to turn. Do I google “mental health”, do I know providers of these services call it “behavioral health”? When I look up a name of a treatment facility is it clear what that facility does? Because of the stigma of these topics, providers over the years have called their facility anything but mental health or substance use.

When someone calls us asking for help or services are we using medical terminology that the caller may not be familiar? Are we listening to them? Is the receptionist equipped with time to listen? Is the receptionist an appointment setter? How far out are your appointments? Do you have a receptionist? Do you have an automated attendant? How many options are in the automated attendant? Stop. Breathe. Writing this paragraph is overwhelming and I want to stop. What about the patient? How many people do we lose right here?

We can fix this. Peer support, community health workers and a paraprofessional workforce are necessary, not only to stretch the dollars of your agency, but to fill gaps where there is a shortage of licensed professionals and to listen when our licensed professionals are short on time. Use this workforce to make linkages in the community to build additional supports around your patients. Seventy percent of people dealing with chronic disease of any kind will fail without support.

There are many other gaps to fill along the treatment lines, but let’s start here for the front lines.  I promise good things will continue to evolve if we start at the beginning and address the tiniest of barriers along the way.

So, we want to talk policy change, access, affordability, HIPAA (Health Insurance Portability and Accountability Act of 1996). No, actually we don’t, but let’s do. Did you remember that’s what HIPAA stood for? How many acronyms do you use in your line of work? Have you substituted them for words so much in your everyday course of business that you forgot lay people and many lawmakers have no clue what that means?

If you want a law maker to champion your cause, keep it simple. Make a 3 x 5 card that can fit in their pocket and type your message clearly in bullet points in a font they can read quickly. If your message doesn’t fit on the card, it is too long. You’ve lost your opportunity. They have to “sell” this to all of the other law makers who are hearing everyone else’s causes. Create meaningful phrases, in language that everyone can understand, that identifies the problem as well as a good attainable solution and drive it home. Share that message with as many lawmakers as you can so they are all familiar with the same language and message.

Sometimes we actually have good laws on the books, but no one knows they exist. Cite that law, get it to law enforcement the same way. Be clear of the consequences. Work together! When a law is outdated work together to change the language. In Indiana, the laws are so old that words like “retardation” were used until 2015 when the governor signed a law to strike the word “retardation” from the Indiana Code and replace with the words “intellectual disability”.[i]

Problems with access are huge to address. Look at each entry point, whether a person has insurance, or not. Identify each step along the way. How long does each step take? Who can help explain the process and next steps to your patients? Access is a barrier because many policy makers have forgotten that they are in the human being business. It’s not a machine. It’s not a “one-size-fits-all” possibility. To make access possible, the highest policy maker has to walk through the steps and process of many scenarios which pose gaps, which demonstrate where we need attention and what clear steps need to be taken to benefit the most people.

The Affordable Care Act (ACA) brought about change. After the first year, gaps in the policy were noticeable. Lawmakers identified some of the glaring ones, but there are still some holes to fill. A system that is constantly improving is possibly a good system. A system that is stagnant and doesn’t progress with the times, technology and most importantly, the people they are serving is not a good system.

For every agency who has ever uttered the words “This is the way we’ve always done it.”, I ask that you pause before ever saying that phrase again. If the COVID-19 pandemic taught us anything, we’ve learned to be resilient and adaptable. We can think out of the box. We can get creative. Let’s take a necessary breath and discover as a team the value of our employees and our patients. What do we need to make these changes?

Support your ask with evidence. Don’t ask a lawmaker to champion your cause until you have demonstrated your cause with effect. When you are advocating, remember to advocate for something. Advocating against something makes you look like a bully. Remember what you are advocating for. Your passion can be infectious.

Look at one small thing that is within the scope of what you are currently doing and make it happen. Know “you” are making a difference.