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The Time Is Now: How Employers Can Address Access and Outcomes in Mental Health 

As the federal public health emergency of the COVID-19 pandemic expires, our focus must return to the ongoing epidemic of mental and behavioral health in this country, which was only exacerbated by the pandemic. According to the National Alliance on Mental Illness’s Mental Health by the Numbers report, one out of five adults in the United States experience mental illness each year, and one in 20 U.S. adults experience serious mental illness each year.  

With rising rates of reported mental health disorders, the onus is on providers and payers to ensure equitable and affordable access to care, particularly for the most vulnerable demographics: children, teens, and those living in rural areas. 

The statistics for children and teens are dire: 

  • 1 in 6 U.S. youth aged 6 to 17 experience a mental health disorder each year. 
  • 50% of all lifetime mental illness begins by age 14 and 75% by age 24. 
  • Suicide is the second leading cause of death among people aged 10 to 14.   

Emergency room visits for mental health issues have spiked over the last decade, particularly for children, teens, and young adults, with the greatest increase in suicide-related visits. 

In addition to a great need for mental health care for young people, we can’t ignore the disparities in access between the rural and urban areas of the country. The Journal of Clinical and Informational Science reports that approximately one-fifth of the U.S. population lives in a rural area, and about one-fifth of those living in rural areas—or about 6.5 million people—have a mental illness. This makes remote and virtual access to care an essential element of any mental health strategy. 

Expanding mental and behavioral health access is the necessary first step in order to create both upstream and downstream impacts on mental health. Here’s how we can address mental and behavioral health today in order to create a more equitable and healthy future for today’s children and tomorrow’s adults. 

Improve Access Through Primary Care and Telehealth Services 

Even within the insured population, a subset of our youth still doesn’t have access to mental health services. Additionally, not one state in the United States has an adequate supply of child psychologists, with the majority of states reporting a severe shortage.  

The first step in mitigating these issues is to ensure access to primary care. Primary care physicians are both the first responders and the gatekeepers when it comes to mental illness. They are also in a position to build a relationship with patients through repeat visits as children go through developmental stages and require varying types of care. 

In terms of driving primary care access, large, self-insured employers have the greatest leverage in the U.S. healthcare system. That’s because 156 million, or 49% of all Americans, were insured through their employers in 2021

Within primary care clinics, emphasis must be placed on integration of mental health screening into visits and, when needed, making referrals based on quality of specialists, not on revenue-sharing. Looking to the future, the ideal scenario is a primary care office that includes a quality mental health worker on-site. This supports continuity of care and reduces the stigma surrounding this specialty, normalizing mental and behavioral health as part of the overall health of the patient base. 

Prompt care is an integral part of the access equation when it comes to mental health. Prior authorization requirements or medical necessity forms can create delays and hiccups in access to care, as well. And for a person experiencing a mental health crisis, delays in accessing care can lead to a rapid worsening of outcomes, including the risk of suicide. In mental health care, responsivity at the exact time of need is essential. Today, organizations are directly addressing this need through tools that allow patients to request an appointment and be seen within 15 days or less compared with the average of 4 to 6 weeks. 

Telehealth services complement an in-person relationship with a primary care provider, but we must address those who don’t have convenient access to in-person care, as well. While telehealth services are key to reaching Americans who live in areas with mental health provider shortages, there are still barriers that lead to a lack of access. Expanding access to mental and behavioral health care via telehealth can help, though it’s important to acknowledge it isn’t a perfect or an equitable solution; virtual care requires an on-demand, private, and stable Internet connection, which is a barrier for many.  

Focus on Affordability and Aligned Incentives 

Access is intrinsically bound with affordability and outcomes. This means we must take steps to expand affordable mental health care, including both in-person and telehealth visits that are covered by payers, and greater awareness and expansion of services like the National Association of Free & Charitable Clinics (NAFC), which offers free and low-cost mental health care. 

It’s one thing to assert that payers should cover mental health care, but it’s another to create alignment in the system to support that decision. To effect broader change, payers and providers must be incentivized toward patient outcomes. The Center for American Progress reports that “insurers often offer providers low payment rates, limiting willingness of an already insufficient workforce to join networks and impeding compliance with network adequacy standards.” 

It’s clear that moving the needle here requires payers to align payment of providers with outcomes. And who has the ability to influence payers? In my experience, large, self-insured employers have the greatest leverage with providers, hospital systems, and insurance companies. The opportunity to evaluate payers based on mental health access, affordability, and outcomes—at the same time—is one that’s often exclusive to organizations with significant numbers of covered lives. 

Mental and behavioral health care in America is a complex issue that requires our urgent attention. However, in parallel with the rise in mental illness, we are also seeing a reduction in stigma, integration with primary care, a growing consumer desire for telemedicine, and demand for payers to reexamine coverage and fee structures based on outcomes rather than volume. The charge today is to build on these foundational elements in order to expand access to every American who needs affordable and effective mental health care.  

Robert Andrews is the CEO of Health Transformation Alliance.

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