Mental Health

Mental health conditions and substance use disorders, known collectively as behavioral health conditions, affect millions of people in the United States every year. Treatment for mental health conditions, such as anxiety and depression, can help people manage their symptoms and improve their quality of life.

However, there are a number of issues concerning access to mental health treatment. For instance:

• Individuals with insurance may have difficulty finding an in-network provider. Once they do, they may struggle to navigate administrative approval processes and coverage limitations.
• The availability of qualified behavioral health providers in the United States has also been a persistent challenge. Financial, educational, and workplace barriers pose challenges to recruiting and retaining providers.
• Additionally, the COVID-19 pandemic—and the resulting social isolation, stress, and unemployment—has increased the number of people with behavioral health conditions, but has made access to in-person treatment more difficult. Also, certain populations may be at greater risk for behavioral health effects due to the pandemic.

Populations Cited by the Most Stakeholders as Being at Higher Risk of Behavioral Health Effects

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Multiple federal programs are working to address these issues, but additional federal actions could improve care for the individuals who rely on these programs. For example:

• Medicaid’s Certified Community Behavioral Health Clinics demonstration program provides states with additional funds for clinics that offer a comprehensive range of mental health and substance use disorder services. However, when these clinics are also certified as another provider type under Medicaid, there is a risk of duplicate payments (i.e., two payments for the same services for the same beneficiary on the same day). Additionally, as of May 2021, HHS had not fully evaluated the effectiveness of this demonstration program.
• Military servicemembers may experience mental health conditions as a result of exposure to dangerous and traumatic situations. The Department of Defense (DOD) has reported that suicide rates among servicemembers increased by one-third between 2016 and 2020. Servicemembers assigned to remote installations outside the U.S. may be especially at risk for suicide because of less access to mental health services and increased social isolation. However, DOD has not fully assessed suicide risk at such installations.
• DOD provides care for servicemembers and their dependents through TRICARE, which includes DOD-run military treatment facilities and private providers. In FYs 2017-2019, about 36% of TRICARE beneficiaries received mental health diagnoses during the perinatal period—pregnancy through one year postpartum. However, they did not all receive mental health treatment.
• Veterans are 1.5 times more likely to die by suicide than the general population. The VA has made efforts to meet an increased demand for mental health services and prevent suicide, though challenges remain. For example, veterans living in rural areas have an elevated risk of death by suicide, and rural provider shortages may mean these veterans have less access to mental health treatment.
• Additionally, veterans with serious mental illnesses, such as schizophrenia and bipolar disorder, may need intensive mental health care programs. Although the Veterans Health Administration (VHA) uses to data to monitor access to these programs, it doesn’t compare access for veterans living in rural areas with those living in urban areas. Doing so would help VHA understand how effectively its intensive mental health care programs are reaching rural veterans.
• One way the VHA has addressed the demand for mental health services is by integrating mental health into primary care settings. Doing so can give veterans access to mental health providers, such as psychologists and social workers. Although VHA requires facilities that serve over 5,000 veterans per year to have integrated mental health care, not all facilities met this requirement as of February 2022. Furthermore, VHA does not monitor these facilities’ efforts to meet the requirement.