World Mental Health Day on October 10 reminds us of the importance of accessible, affordable mental healthcare for patients across the globe. While we have seen significant progress — much of it thanks to hospitals and healthcare professionals who are integrating mental and physical healthcare and expanding awareness of mental health resources — there can still be barriers to accessing mental healthcare, including the harmful practices of certain corporate insurance companies that too often prioritize profits over patient care.
Today, one in five Americans struggle with mental health issues. Half of young adults reported they felt anxious always or often in a 2022 study, and 18-to-25-year-olds are nearly three times more likely to experience a mental illness than individuals 50 and older. Rates of substance use have steadily increased over the past two decades, and suicidal behavior among high school students rose more than 40 percent from 2009 to 2019. It’s not hard to see why nine in 10 Americans agree we are experiencing a mental health crisis.
Sadly, despite growing awareness around mental health needs, millions of Americans still lack access to care. Over half of adults with a mental illness received no treatment last year, and more than a quarter of those who went untreated said they experienced serious psychological distress within the prior month.
Insufficient access to care remains one of the biggest barriers across the U.S. There are 340 Americans to every one mental healthcare provider in our nation, according to Mental Health America’s 2024 State of Mental Health report. Those numbers look even worse when adjusted to account for providers who are no longer practicing or no longer accepting new patients. A stunning 75 percent of rural counties across America are mental health deserts.
What’s even more troubling is that millions of Americans who seek mental healthcare are turned away because their insurance refuses to pay for it. As a ProPublica investigation reported earlier this year:
“Although federal law requires insurers to provide the same access to mental and physical health care, these companies have been caught, time and again, shortchanging customers with mental illness — restricting coverage and delaying or denying treatment.”
The investigation found that certain corporate insurers often refuse to authorize mental healthcare or claim that patients aren’t sick enough for treatment, even when providers document patient needs for care. ProPublica reported, “More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.”
Corporate insurers can also make it difficult to access behavioral care due to narrow or “ghost networks” that consist of inaccurate provider lists. When looking to see a mental health provider, many patients find that the providers listed in their insurer network are either retired, dead, or no longer accepting their insurance. In 2023, the Senate Committee on Finance found that more than 80 percent of the listed in-network mental health providers for Medicare Advantage plans were “either unreachable, not accepting new patients, or not in-network.” As ProPublica reports, these inaccurate networks “adds up to a bait and switch by insurance companies that leads customers to believe there are more options for care than actually exist.”
Corporate insurers’ profits-over-patients tactics have created a pattern where certain large insurers systemically impede access to mental healthcare. Even though “demand for mental health services is stronger than ever,” over forty percent of Americans say poor insurance coverage and high costs are the greatest barriers for getting the mental healthcare they need. More than a quarter say they have had to choose between getting mental health services and paying for daily necessities.
Profit-seeking corporate insurers, joining forces with shadowy special interests and deep-pocketed donors, have sought to shift blame onto hospitals, pushing policymakers to cut resources from patient care and weaken the local hospitals that stand on the front lines of our country’s mental health crisis.
Hospitals and health systems are transforming the conversation around mental health and changing how mental and behavioral health issues are identified and treated. They are leading the integration of physical and mental health, pioneering diagnostics, treatments and services, and answering our communities’ needs on the ground and in real time. Because as George Brock Chisholm, M.D., the first director-general of the World Health Organization, stated, “Without mental health there can be no true physical health.”
Hospitals are the only medical facilities that receive patients every hour of every day. Especially in rural communities, they can be the only place for 24/7 inpatient mental healthcare. In fact, one in every eight emergency department visits in the U.S. is related to a behavioral health disorder.
New research makes this important point even clearer. A recent study revealed that nearly half of all hospital emergency department visits happen after hours, when there are limited other options for care. And the data show this after-hours access to care is especially critical for mental health emergencies and substance use crises: Two thirds of all overdose-related emergency department visits occurred outside of normal business hours.
World Mental Health Day is a celebration of the progress that’s been made to improve access to and the quality of mental healthcare. It is also a reminder of the distance yet to go to ensure all individuals and families can get the care they need and the importance of holding corporate insurance companies accountable for their practices that delay and deny patient care. Our hospitals are a critical driver of progress, past and still ahead, and they deserve our full support.