Six years after the recession, Americans with mental illness still had limited access to treatment, according to researchers.



US laws meant to improve that access, including the Affordable Care Act (ACA), were unable to overcome the crippling financial impact of the recession on the millions of Americans seeking care, according to a study published Monday in the journal Psychiatric Services.

“The study creates this picture of people who may have been marginally functioning, who were pushed over the edge and they just couldn’t get back: they couldn’t get jobs, they couldn’t back to the life they had before,” said Judith Weissman, the study’s lead investigator.

More than 8.3 million people have serious psychological distress (SPD), which indicates a person is likely to have a mental health problem that interferes with their life.

In 2014, the year the ACA was fully implemented, 9.5% of Americans with SPD did not have access to health insurance that could connect them with a counselor or psychiatrist, a small rise from 2006, when 9% of the population reported the same thing, according to the study.

Weissman, a research manager at New York University’s Langone medical center, said this population was worse off in 2014 than it was in 2006 when it comes to healthcare utilization, which is measured by things including an inability to get needed prescription drugs or delays in accessing treatment. “There is something very broken about the way we provide mental healthcare in the country,” she said.

Patterns in access to care between 2006 and 2014 were similar among adults with and without SPD. Both groups experienced a steep rise in lack of health coverage after the recession in 2008 and experienced a return to 2006 coverage levels in 2014.

But from 2006 to 2014, adults with SPD who could not afford medication continued to increase, which the study said “suggests they may not have had as complete an economic recovery as adults without SPD”.

Weissman said that while this early analysis suggests the mental health system has failed to bounce back from the economic recession, people are using available healthcare at increasing rates because of changes made under Obamacare. “I think that what we’re seeing now is that – really, likely the impact of the recession on people with mental illness,” Weissman said.

She was one of several researchers at Langone to conduct the analysis, which took four years to complete and is thought to be the first of its kind in more than a decade.

Their study provides a conservative estimate of mental healthcare access and utilization because it does not include the homeless population. In January 2016, one in five people experiencing homelessness had a serious mental illness, according to the Substance Abuse and Mental Health Services Administration.

John Snook, executive director of the Treatment Advocacy Center, a mental health advocacy organization, said he hopes the benefit of the ACA and other laws that expanded mental healthcare access will show up “more robustly” in future studies.

“What you hear from families all the time is it is still a really difficult process to get mental illness treatment – even in states that have expanded Medicaid,” he said. “There may be only one psychiatrist that’s available; she may be an hour and half away.”

He said this analysis provides data that the group has been seeking – and pushing policymakers to collect – for years, to support things the group has observed anecdotally.

Snook said: “As we get better and better data, what we are overwhelmingly finding is that we are doing a terrible job of prioritizing their care and we, as a result, are costing ourselves a huge amount of money and not benefitting this population.”