New Patient Survey Shows Pervasive Disparities in Access Between Mental Health and Substance Use Versus Physical Health Care

Leading mental health and employer groups come together around health system solutions for the nation’s “staggering public health challenge” in mental health.

[JULY 18, 2023, WASHINGTON] – Patients reported stark access challenges in seeking mental health and substance use care and startling disparities between mental versus physical health services in a report released today by The Bowman Family Foundation.

The report, based on a survey of 2,794 patients conducted by NORC, is titled Equitable Access to Mental Health and Substance Use Care: An Urgent Need. The survey found:

  • More than half of patients (57%) who sought mental health or substance use care were unable to access any care on at least one occasion between January 2019 and April 2022.
  • Of patients in employer-sponsored health plans, 39% reported using at least one out-of network provider for mental health or substance use outpatient care, compared to just 15% for physical health care.
  • Of such patients using out-of-network providers, 80% reported using out-of-network mental health or substance use providers “all of the time” versus only 6% for physical health care.
  • Even among patients who successfully made an appointment with a new in-network mental health or substance use provider, 40% had to contact four or more providers.

Findings even more concerning for adolescents

Nearly 70% of adolescents who sought mental health or substance use care did not receive any care on at least one occasion, compared to less than 20% of those seeking physical health care. Primary care doctors provide office-based care for more than half of patients with mental health and substance use conditions and write most prescriptions for psychotropic medications. The survey findings underscore that this care is often insufficient with 98% of adolescents who received mental health or substance use care from primary care providers reporting a need for more help from mental health or substance use specialists. Numerous studies have shown that primary care practices that integrate mental health specialty services improve clinical outcomes, increase patient and provider satisfaction, reduce health inequities, and reduce costs. These integration approaches are crucial for early detection given the deteriorating mental health of adolescents over the last decade and during the COVID-19 global pandemic.

“This report lays out in clear terms what so many Americans feel in day-to-day encounters with the health care system, even when they think they are covered by insurance, whether it’s Medicare, Medicaid, or Commercial,” said Henry Harbin, MD, senior author of the report. “We recognize that insurers are providing a relatively high level of in-network access to the full range of specialty medical and surgical care for physical health diseases such as cancer, heart disease, and diabetes, despite workforce shortages among some of these medical providers. Our goal is the same effective access and outcomes for mental health and substance use.”


The report, which includes findings from eight other studies of network access, the majority of which are from 2022 and 2023, calls on all stakeholders – payers, providers, regulators, and legislators – to expand enrollment of mental health and substance use providers in payer networks; to drive the adoption of proven methods of integrating effective mental health and substance use services within primary care physician and pediatrician offices; to ensure reimbursement for tele-behavioral health at the same level as reimbursement for in-person care; and to demand full compliance with the federal and state parity laws already on the books.

“This report shows what employers have known and struggled with for years; timely access to in-network mental health providers is difficult to achieve for several reasons,” said Mark Wilson, Chief Economist at the HR Policy Association. “While large employers have implemented some benefits strategies to address the shortage of providers, addressing other systemic industry issues will take a concerted effort by all stakeholders. HR Policy Association represents three quarters of Fortune 500 employers, and we’re committed to improving mental health and substance use access despite these workforce challenges.”

Supporters of the report recommendations include:

  • American Foundation for Suicide Prevention
  • American Foundation for Suicide Prevention – GA
  • American Health Policy Institute
  • Association for Behavioral and Cognitive Therapies
  • Dallas-Fort Worth Business Group on Health
  • Eating Disorders Coalition for Research, Policy, & Action
  • Florida Alliance for Healthcare Value
  • Georgia Mental Health Policy Partnership
  • The Goodness Web
  • HealthCareTN
  • Houston Business Coalition on Health
  • HR Policy Association
  • The Jed Foundation
  • Kansas Business Group on Health
  • The Kennedy Forum
  • Legal Action Center
  • Mental Health America
  • Mental Health Association of Maryland
  • MidAtlantic Business Group on Health
  • NAMI, National Alliance on Mental Illness
  • NAMI Minnesota
  • National Alliance of Healthcare Purchaser Coalitions
  • National Association for Behavioral Healthcare
  • National Association of Addiction Treatment Providers
  • National Council for Mental Wellbeing
  • Northeast Business Group on Health
  • Northwestern University, Center for Behavioral Intervention Technologies
  • One Mind PsyberGuide
  • Purchaser Business Group on Health
  • REDC Consortium
  • Shatterproof
  • Steinberg Institute
  • Sylvan C. Herman Foundation
  • Texas Business Group on Health
  • Treatment Advocacy Center
  • Young People in Recovery

About The Bowman Family Foundation The Bowman Family Foundation (“BFF”) is a private foundation qualifying as a 501(c)(3) nonprofit organization. The primary mission of BFF is to improve the lives of people with mental health and substance use conditions. BFF also provides funding to support the education and welfare of children. BFF is the Managing Member of the Mental Health Treatment and Research Institute LLC (“MHTARI”), a tax-exempt subsidiary of BFF which conducts most BFF activities regarding mental health and substance use conditions. The survey conducted by NORC and preparation of the report were funded by MHTARI. Learn more at www.thebowmanfamilyfoundation.org.

Media Contact
Lauren Green
West End Strategy Team


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