During the pandemic, social isolation, uncertainty, and financial instability became a daily reality for many, stretching our mental health to the limit and for some to the point of crisis.
Unfortunately, North Carolina has never had adequate mental health services because it’s unaffordable for most people. Until we close the coverage gap for the more than 1 million uninsured North Carolinians and employers ensure their health plans adequately cover mental health services, needed care in our communities will remain out of reach.
Mental illness is incredibly common. Roughly 1 in 5 Americans will experience a mental illness – that’s about 2 million North Carolinians. Yet, in 2019, according to the National Alliance for Mental Illness, more than 55% of people did not receive treatment – that’s more than 1 million North Carolinians who went without care.
According to the 2018 National Survey on Drug Use and Health, the number one reason people do not get the care they need is cost.
More than 1 million North Carolinians have no insurance at all, including an estimated 142,000 uninsured children. Historically, state funding provides $275 million per year for safety-net behavioral health services, allowing about 100,000 uninsured individuals to receive care, leaving hundreds of thousands of others who need care, with nothing.
On top of that, half of North Carolinians cover their health care needs through employer-sponsored health insurance. According to a 2019 Milliman Study, North Carolinians have to pay out-of-network fees for mental health care 750% more often than for physical care. Also, insurance consistently reimburses less for mental health care than physical health care.
And just like any other service or product – when no one pays for it – it is not available when you need it. It’s getting harder for people to find a mental health provider – 27 counties in NC do not have a psychiatrist. And while millions have been spent to build local psychiatric beds, insufficient insurance coverage keeps them empty; only 52% of the licensed beds are used daily.
All of this leads to behavioral health patients waiting in emergency departments across the state. And for some, untreated mental illness can lead to homelessness, involvement with the justice system, trauma to children, increased physical health problems and inevitably will drive-up other costs – financial and moral.
This problem demands our collective action. Starting with expanding Medicaid. The National Council for Behavioral Health identified that Americans with mental health and substance abuse disorders were the single largest beneficiaries of Medicaid expansion. And the Kaiser Family Foundation points to more than a dozen studies that show Medicaid expansion improves mental health care access and outcomes.
Employers can also ensure their sponsored benefit plans provide the care necessary to promote a healthy and productive workforce. It’s a worthwhile investment – depression alone caused $44 billion to be spent on lost productivity. We should work together to study our existing laws to ensure our mental health needs are covered just as well as our physical health needs.
There is much to do: increasing the pipeline of mental health providers, enabling the use of mental health, creating consultation services to expand the reach of psychiatry into primary care, supporting resiliency and stability in families, funding brick-and-mortar crisis centers, supporting justice-involved diversion, and much more. We are committed to these changes. However, if we don’t make it possible for folks to afford care, nothing else we do will make a lasting difference.
Kody Kinsley is the chief deputy secretary for health at the NC Department of Health and Human Services, Carrie Brown, MD, MPH, is the department’s chief medical officer for behavioral health and intellectual or developmental disability.