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Tuesday, November 29, 2022 | The Latest Research, Commentary, And News From Health Affairs
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Mental Health Needs In 2022
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Nearly three years into the pandemic, there are lingering questions about how to meet the increased demand for mental health services.
A key finding from the 2022 Employer Health Benefits Survey was that 48 percent of large firms offering health benefits reported seeing an increase in the share of employees using mental health services in the past year.
Among large firms offering health benefits, 29 percent saw an increase in the share of employees who requested leave for mental health conditions under the Family and Medical Leave Act and 43 percent were at least somewhat concerned about the growth of substance use conditions among their employees.
Employers can play an important role in facilitating access to mental health services—about half of nonelderly people, or more than 155 million people, were insured through employer-sponsored health plans.
Employers frequently adapt their health plans to incorporate new options and many sponsor programs outside of their plans to help employees manage stress and promote healthy living.
Even prior to the pandemic there was concern about access to mental health care.
In 2019, among the 21.6 million adults who reported moderate to severe symptoms of anxiety and/or depression, 39 percent were not receiving treatment.
In addition to personal hesitancy, a number of access issues may contribute to individuals not receiving such care, including costs, not knowing where to obtain care,
mental health provider shortages, and low rates of insurance acceptance.
During the pandemic, the share of adults reporting symptoms of anxiety and/or depression has grown and roughly a quarter of adults experiencing these symptoms report unmet mental health needs.
A KFF/CNN survey found that during the summer of 2022, 90 percent of Americans believed that the country faced a mental health crisis and 68 percent indicated the opioid epidemic was a crisis.
Employers have taken notice of worsening mental health and an uptake in use among their employees. Many employers have made changes to the mental health services they offer over the last two years.
In 2022, 81 percent of large employers offered employee assistance programs
(EAPs) and 44 percent offered mental health self-care apps; 61 percent added additional digital content to their wellness programs in the past two years.
Throughout the pandemic there has been a blossoming of vendors and digital tools to promote mental health and well-being. While employers have leaned on these resources, it is unclear which of these programs are effective at improving mental health, and how to incorporate them into comprehensive care.
In our survey, many large employers report that digital content received limited engagement from employees and relatively few indicated that their wellness programs more broadly were "very effective" at improving health and well-being.
In contrast to the high share of employers offering EAPs and self-care apps, relatively few took steps to bolster the availability of in-network providers.
Our survey highlights employers concern with the robustness of provider networks for mental health services.
Narrow network plans may reduce a plan’s cost by excluding high-cost providers, but limited provider options in these plans may pose access barriers for enrollees and an increased risk of enrollees resorting to out-of-network providers and thus higher costs.
In 2022, nearly 20 percent of large firms offering health benefits said that their provider network
for mental health services was either somewhat or very narrow, compared to only 6 percent for providers overall.
Additionally, only 52 percent of large firms believed there was a sufficient number of behavioral health providers in their plan’s network to provide timely access to services.
In comparison, 89 percent of large firms believed that there was a sufficient number of primary care providers to provide timely access to services.
Despite this, relatively few large employers offering health benefits expanded the availability of mental health services by adding new providers or facilities for in-person care (14 percent) or by adding new virtual providers (22 percent) over the past year.
One challenge to building robust provider networks for mental health care services is the ongoing shortage of providers. Nationally, only 28 percent of the need for mental health practitioners was met as of September 2022 (this measure is primarily based on the number of psychiatrists relative to the population).
Psychiatrists are also significantly less likely than other physicians to accept any new patients with private insurance, raising further concerns about access to psychiatrists and potentially other mental health practitioners.
Telehealth services have emerged as an important pathway to mental health care during the pandemic and may alleviate some concerns about provider access, particularly in rural areas.
By 2021, nearly 40 percent of all mental health outpatient visits were delivered through telehealth.
Findings from our 2022 Employer Health Benefits Survey showed that employers offering health benefits are optimistic about the future of telehealth, with more than half of large employers indicating they believe it will be "very important" in providing access to behavioral health services going forward.
Although telehealth can help broaden access to mental health services, it is generally intended to supplement, not replace, in-person services.
The pandemic and its impact on mental health and substance use has shined a light on barriers to care.
In addition to changes from employer-sponsored health plans, recent federal policies aim to expand the mental health workforce, though these actions will take time to materialize.
In the meantime, employers will likely continue to grapple with meeting the behavioral health needs of their employees amidst workforce shortages and increasing costs, and individuals with mental health needs will continue to navigate a variety of access challenges.
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| Abdinasir Ali On State Eviction Moratoriums' Impact On Health
Health Affairs Editor-in-Chief Alan Weil interviews Abdinasir Ali from the University of Iowa College of Public Health on his research assessing the effects of state eviction moratoriums on mental health.
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Elsewhere At Health Affairs
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Use promo code: 40for40 and choose 40% off:
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Lillie J. Tyson Head and Christopher F. Koller
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About Health Affairs
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