Recent research finds that 1 in 5 Americans experience some form of mental illness, a statistic certainly influenced by the Covid crisis.
However, an encouraging outcome of the pandemic has been increased momentum behind the trend of Americans being more willing to speak openly about mental health challenges.
With that said, according to 2021 research from the Mental Health Million Project, it is still the case that 45% of Americans who have a clinical-level mental health disorder do not seek professional help.
Unsurprisingly, the stigma associated with seeking mental health counseling drives much of this resistance as well as a lack of confidence in mental health services.
But as well, cost barriers – both real and perhaps perceived – also have the effect of people not getting the help that they need.
Twenty-five percent of Americans surveyed who did not seek help cited cost as a factor.
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What About Insurance Coverage?
Since 2014, any Affordable Care Act (ACA or Obamacare) compliant health insurance plan must cover mental health and addiction services, with no annual or lifetime dollar limit.
As one of the ten essential health services under ACA, you cannot be denied coverage for a pre-existing condition. Nevertheless, significant gaps exist that impact the affordability of care even when insured.
For example, mental health providers are more likely to be out-of-network and so the patient incurs a much higher cost. As well, there are gaps in prescription coverage.
Many psychiatrists do not accept insurance at all, limiting the availability of their services to those who can afford to pay entirely out-of-pocket.
Finally, for many low-income Americans who live in one of the dozen states that continue to refuse to expand Medicaid coverage, there is no ACA option at all for mental health services.
If you do have insurance coverage, will you use it?
Many people are drawn to high deductible health plans (HDHPs) because of their lower monthly premiums and the undisputed tax benefit of their sibling, the Health Savings Account (HSA).
HSAs are triple tax advantaged: contributions to the account from your paycheck are made pre-tax lowering your tax liability that year, money invested in the account grows tax-free, and any withdrawals from the account are as well free from tax if used for a qualified medical purpose.
The trade-off is much higher out-of-pocket costs until the annual deductible, co-pays, and co-insurance are met.
According to recent research from the Employee Benefit Research Institute, persons suffering from anxiety, depression, and attention deficit disorder were markedly less likely to seek mental health services under an HDHP, as opposed to those with “traditional” insurance.
These services offer access to a licensed therapist through videoconference, telephone, live chat, and text message.
Compared to traditional counseling, this type of therapy is reasonably priced, about $60 to $90 per week, although some service packages can be pricier. (Traditional therapy can be as much as $250 per session, with most people experiencing a price tag between $100 and $200.)
Price does matter because although both companies accept health insurance, even with insurance, cost gaps can exist.
Is this new model of mental health therapy effective?
Earlier research from the last decade certainly indicates that remote counseling by phone can be effective, comparable to in-person sessions.
There is, however, the need for more research on the effectiveness of these newer modalities of delivering mental health assistance which have exploded in popularity since the pandemic.
Encouragingly, remote therapy may be a way to close the urban-rural divide in access to mental health services.
A 2015 report on access to mental health care cited a finding that in the majority of US counties, there’s no practicing psychiatrist, psychologist, or social worker. More recent reports continue to find a critical shortage of mental health workers in the country.
Employee Assistance Programs (EAPs) can be a low or even no-cost avenue to getting the care that you need.
EAPs, which are widely available as an employee benefit at larger US employers, frequently include access to trained counselors to address issues such as substance or alcohol abuse and grief counseling, among other mental health concerns.
In addition to the direct cost of seeking help, the need to take time away from work could introduce indirect mental health costs.
After using paid sick leave or other types of paid leave, what other options exist?
The Family and Medical Leave Act (FMLA) requires larger employers to provide time off to care for health needs, either your own or those of a family member, for up to 12 weeks. FMLA includes mental health needs. However, FMLA does not require your employer to pay you during your time away.
The Americans with Disabilities Act (ADA) also provides an avenue for those experiencing mental health concerns to continue their careers as they engage in therapy.
Under ADA, a worker has the right to seek reasonable accommodation for their condition. In the mental health sphere, this may mean a distraction-free or quieter environment, flexible scheduling to accommodate appointments or medication, or changes in work routines to lessen anxiety.
The ADA National Network provides an extremely useful guide for both employers and employees on how ADA can tangibly support mental health in the workplace.
Access to mental health services is a glass half full. The price tag of getting assistance remains a barrier for many, even with insurance.
On the other hand, newer service delivery options and the popularity of EAPs increase the availability and convenience of mental health support.
Most importantly, Americans are increasingly aware of the need to prioritize and vocalize their mental health needs and seek help.