Restructuring how we value and reimburse providers is critical.
Imagine that you’ve been feeling down or hopeless, and decide it’s time for professional help. Except when you start searching, it’s hard to find a therapist who takes your insurance or lives in your area. Besides, how do you know if the person is right for your needs and background?
These are frustratingly common issues for many. More than 122 million Americans live in “mental health deserts” where providers are in short supply. Projections through 2036 show significant shortages of counselors, psychologists, therapists, and psychiatrists, according to the The National Center for Health Workforce.
Unfortunately, the problem isn’t new.
“We’ve always had a mental health and substance use provider shortage in America,” said The Kennedy Forum Chief Policy Officer Nathaniel Counts, J.D.
Counts has provided policy guidance for the City of New York and Mental Health America, and says that while a number of factors contribute to a provider shortage, one root cause is quite straightforward.
“A key variable is how we pay and value these professionals in our systems of care,” he said.
“It always comes back to how we enforce mental health parity.”
Fair Payments Though Mental Health Parity Can Help the Shortage
According to Counts, consistent health insurance coverage of mental health in the U.S. is fairly recent, and was not necessarily built to meet the full range of patient or provider needs. In 2008, the The Mental Health Parity and Addiction Equity Act (MHPAEA) sought to change that, by ensuring equal insurance coverage for conditions of the mind and reimbursing providers more fairly.
Yet the law went largely unenforced, and the way that insurers reimbursed mental health/substance use experts for their services remained lopsided as compared to medical care — even when the skills, training, and credentials are similar. Additionally, the provider networks offered by insurers are often small and insufficient.
According to a report by RTI International, the average reimbursement rate for office visits was 27.1% higher for medical/surgical physicians than those who provide mental health/substance use health care. On the patient side, users went out-of-network 3.5 times more often for mental health and substance use needs.
These inequities are particularly acute in fields that are undervalued and underutilized for mental health and substance use care.
“Nurses, social workers, peer support specialists, and other people in vital jobs are very underpaid and under-reimbursed compared to many of the jobs you can have in health care,” Counts said. “For instance, it is hard, challenging work doing community outreach for individuals who are unhoused and experiencing a mental health crisis. Yet these tough roles aren’t compensated as such.”
How Do We Pay for It?
Inevitably, more equitable pay for providers is met with a reasonable question: How will we fund it?
Instead of thinking only of the costs, Counts says, we must consider the potentially immense long-term economic benefits of a healthier society facilitated by these experts. “There are studies that have found the positive labor force impacts may outweigh the additional health care spending.”
The World Health Organization estimates that 12 billion working days and $1 trillion in productivity are lost to mental health issues per year. As we face a rapidly declining workforce pool, increasing demand for care, and less providers overall, these losses could prove economically cataclysmic.
“Unaddressed mental health and substance use needs lead to cascading consequences not just for the person impacted, but for society more broadly.”
“At the most extreme ends, people leave the labor force entirely, and maybe even end up intersecting with the criminal legal system,” Counts said.
However, Counts describes a system that values mental health parity — and the providers and patients who benefit from it — as one that would ultimately contribute to the entire well-being of society.
“In an ideal world, the one we’re working toward via our 90-90-90-goals, you could routinely be screened or self-report and expect that you’d be connected to timely care. Then, you’d have options to choose someone who meets your needs who has competency in your background and offers a range of therapeutic options. Finally, you’d have the chance to pursue the amount of treatment at the intensity you need until you feel better,” Counts said.
“Ultimately, some things are just worth figuring out.”
To learn more about what The Kennedy Forum is doing to ensure mental health parity, or to see the latest updates on mental health parity legislation, sign up for emails to get important news, alerts, and more. Or, follow The Kennedy Forum on LinkedIn.
