December 11, 2018

Mass. residents having trouble accessing behavioral health care, survey shows

Most adults who sought care for mental health or substance use disorders in Massachusetts in the last year had trouble obtaining that care, regardless of whether or not they had insurance coverage to help pay for the care.

The 2018 Massachusetts Health Reform Survey found that more than a third of the people who sought behavioral health care in the last 12 months have gone without that care and that 57 percent of the people who sought care said they had trouble finding a provider who would see them.

The Blue Cross Blue Shield of Massachusetts Foundation on Tuesday morning will release the results of the survey conducted by the Urban Institute and Social Science Research Solutions earlier this year based on responses from 2,201 individuals.

"I think all in all, it's sort of another set of data that indicates what we all sort of anecdotally experience and hear about: that there are real access problems with getting mental health and substance use disorder care," Audrey Shelto, president of the Blue Cross Blue Shield of Massachusetts Foundation, said. She added, "In a state where we have made such dramatic gains in coverage, it is disturbing that so many people with mental health and substance use conditions face these challenges in getting treatment."

The survey found that Massachusetts is sustaining the coverage gains made in the wake of the 2006 health care reform law. In 2018, 96 percent of adults had health insurance and 87.6 percent maintained their coverage throughout the entire year. But Shelto said the state "must do better" when it comes to behavioral health "given the toll that these conditions take on individuals and their families, as well as their overall health."

Despite the high rates of insurance in Massachusetts, the survey found that having coverage doesn't assure a patient access to behavioral health care. Among adults with health insurance who sought mental health or substance use treatment in the last year, 55 percent reported difficulties accessing that care, the survey found.

Affordability of behavioral health services was also an issue that the survey identified as a problem regardless of insurance coverage. The survey found that a majority of the people who sought mental health or substance use disorder care in the last 12 months reported a problem with affordability.

These barriers, Shelto said, are prompting more people to seek care from a hospital emergency department, where the cost of health care can become far more expensive.

"People are either going without care, which is what a third of people are doing, or they are turning to the emergency department for care that they themselves say they could have gotten in the community if they could have found someone to give it to them," she said.

The 2018 Health Reform Survey, the latest in a series of surveys designed to track trends in the health care system since the 2006 reform, was the first to include questions about access to behavioral health care, Shelto said. She said that the foundation will "definitely" continue to include those questions given the findings.

Though the report of the survey's results focused on the barriers to access to mental health and substance use disorder treatment, the survey also found that access and affordability can be problematic in the health care system at large.

Just under half (49.1 percent) of adults reported difficulty obtaining health care generally over the last 12 months and 38 percent said they went without needed health care during the same period, including 18.6 percent who said they went without needed care because of the cost, the survey found.

"The big picture theme is that we as a commonwealth are doing great in terms of coverage -- we accomplished health care reform and we've been sustaining a leadership role in the country in terms of coverage," Shelto said. "But coverage doesn't equal access or affordability. We want to get to the national leadership position on these issues as well but we have more work to do."

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