Insurance Status, Use of Mental Health Services, and Unmet Need for Mental Health Care in the United States

TLDR

The study aimed to update national estimates of mental health service use, unmet need, and barriers among adults with mental disorders, and to identify strategies to reduce structural and attitudinal obstacles. Using data from 36,647 adults in the 2011 National Survey on Drug Use and Health, the authors applied logistic regression to examine predictors of treatment utilization and perceived unmet need. Results showed that 62% of adults with any mental illness and 41% with serious mental illness did not receive treatment, 21% and 41% reported unmet need, insurance was associated with higher treatment use and lower unmet need, and 72% of those with unmet need cited structural barriers while 47% cited attitudinal barriers, underscoring persistently low treatment rates and high unmet need.

Abstract

Objective: The purpose of this study was to provide updated national estimates and correlates of service use, unmet need, and barriers to mental health treatment among adults with mental disorders. Methods: The sample included 36,647 adults ages 18–64 (9,723 with any mental illness and 2,608 with serious mental illness) from the 2011 National Survey on Drug Use and Health. Logistic regression models were used to examine predictors of mental health treatment and perceived unmet need. Results: Substantial numbers of adults with mental illness did not receive treatment (any mental illness, 62%; serious mental illness, 41%) and perceived an unmet need for treatment (any mental illness, 21%; serious mental illness, 41%). Having health insurance was a strong correlate of mental health treatment use (any mental illness: private insurance, adjusted odds ratio [AOR]=1.63, 95% confidence interval [CI]=1.29–2.06; Medicaid, AOR=2.66, CI=2.04–3.46; serious mental illness: private insurance, AOR=1.65, CI=1.12–2.45; Medicaid, AOR=3.37, CI=2.02–5.61) and of lower odds of perceived unmet need (any mental illness: private insurance, AOR=.78, CI=.65–.95; Medicaid, AOR=.70, CI=.54–.92). Among adults with any mental illness and perceived unmet need, 72% reported at least one structural barrier and 47% reported at least one attitudinal barrier. Compared with respondents with insurance, uninsured individuals reported significantly more structural barriers and fewer attitudinal barriers. Conclusions: Low rates of treatment and high unmet need persist among adults with mental illness. Strategies to reduce both structural barriers, such as cost and insurance coverage, and attitudinal barriers are needed.