Massachusetts residents struggle to access mental health care, study finds

Audrey Shelto is president of the Blue Cross Blue Shield of Massachusetts Foundation. The foundation released a new study on access to mental health care.

Although Massachusetts has some of the country's top health care providers, that health care is not always accessible to residents -- especially those seeking care for mental health or substance use disorders, according to a study released Tuesday by the Blue Cross Blue Shield of Massachusetts Foundation.

"This can't be acceptable in our commonwealth," said Audrey Shelto, the foundatin's president. "We've worked together before on coverage. We need to work together making behavioral health services more accessible to people."

The study found that the lack of available care means people with mental health problems or substance use disorders end up going without care or end up in the emergency room for problems that would have been treatable elsewhere, in a less expensive setting.

"I think it's also not hard to anticipate that if people need mental health and substance use disorder care and they can't get it, and they don't get it, then conditions can exacerbate and result in the need for a more significant treatment level and more expensive treatment," Shelto said.

The foundation's Massachusetts Health Reform Survey is a phone survey of 2,201 adults ages 19 to 64.

The survey found that more than half -- 56.8 percent -- of adults who sought care for mental health or substance use disorders reported difficulties getting that care.

This could mean they had trouble finding a provider who would see them at all, or finding one who would give them an appointment as soon as they needed it. In some cases, the provider was not taking new patients, while in others, the provider would not take the patient's insurance. Among those who sought care, 35 percent were told a provider did not accept their insurance and another 35 percent were told a provider was not accepting new patients.

Likely because of the difficulty finding a provider, 38.7 percent of those who sought mental health or substance use care said they went without it.

Some turned to the emergency room. The study found that 12.7 percent of the adults who sought mental health or substance use care visited the emergency room, around half of them for a non-emergency mental health condition.

A majority of those seeking care in the sample were low-income, and they were disproportionately younger, female and white. But those reporting difficulties represented all levels of income and different races and genders.

The study relied on self-reporting and did not include those already in an institutional setting.

The look at mental health care was part of a broader report on health care access. This is the first year the survey has asked about access to mental health care specifically. While people reported difficulty obtaining all kinds of health care, the unmet need was highest for mental health and substance use care.

The unmet need was not due to a lack of contact with the health system. Those seeking mental health care generally had insurance coverage and had a place they would typically go for medical care.

"It is clear that health insurance does not guarantee access" to mental health and substance use care, the report said. Previous studies have found that 45 percent of Massachusetts mental health providers refuse to take MassHealth, 38 percent will not take Medicare, and 16 percent will not take commercial insurance.

Providers may shy away from public insurance programs because of their low reimbursement rates and administrative hassle.

"While we have a very high number of providers per capita, we also have a lot of providers that don't take insurance coverage -- public or private," Shelto said.

The study suggests that the difficulties are due to insurance reasons, a lack of providers in some geographic areas and the "fragmented" system that provides mental health care.

The foundation, a nonprofit affiliated with the insurance company, has as its mission expanding health care access for low-income and vulnerable individuals.

Shelto said the foundation is finishing a four-year grant in which it worked to better integrate behavioral health with primary care, so people could access mental health care through their primary care doctor.

It is launching another four-year grant program to create more urgent care centers for behavioral health care. Foundation officials have also been talking to state officials about ways to make the administrative process easier for providers willing to take public insurance.

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