Mentally ill accessing less U.S. health care

(Reuters Health) - More than 8 million American adults suffer from serious psychological distress, and they’re less likely to access healthcare services than other people, a U.S. study suggests.

People with serious psychological distress, which includes any mental illness severe enough to require treatment, are three times more likely to be too poor to afford care and 10 times more likely to be unable to pay for medications, the study found.

“Adults with serious psychological distress are more likely to experience delays in healthcare, insufficient money for needed healthcare, change their place of health care, and change their place of healthcare due to insurance,” said lead study author Judith Weissman of New York University Langone Medical Center.

“They are also more likely to have limitations in ability to work, and in activities of daily living compared to adults without serious psychological distress,” Weissman said by email.

For the study, researchers examined survey data on health care use from 2006 to 2014 for a nationwide sample of 207,853 U.S. adults ages 18 to 64. About two-thirds of participants were white and almost one-third had at least a college education.

To assess how many people had serious psychological distress, researchers focused on questions that examined how often participants experienced feelings like exhaustion, hopelessness, nervousness, restlessness, sadness and worthlessness.

Overall, about 3.4 percent of adults, representing more than 8.3 million people, reported serious psychological distress in 2014, up from roughly 3 percent at the start of the study, researchers report in the journal Psychiatric Services.

By the end of the study, 9.9 percent of adults with serious psychological distress couldn’t afford to see a mental health care provider, up from 8.7 percent in 2006, the study found.

The pattern was reversed for adults without these mental illnesses; 8 percent couldn’t afford to see a mental health care provider in 2014, down from 10.7 percent at the start of the study.

Over that same time, the proportion of mentally ill adults who couldn’t pay for drugs climbed from 8.7 percent to 9.9 percent. For people without serious psychological distress, the proportion of adults unable to afford medications dropped from 10.7 percent to 8 percent.

Access and affordability appear to have worsened for people with serious psychological distress despite two U.S. laws designed to do the opposite: the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act (ACA), or Obamacare, the researchers note.

One limitation of the study is that researchers only had one year of data under the ACA, which might not fully account for changes in access or affordability in subsequent years, the authors note. Researchers lacked data to examine how different states’ approaches to expanding Medicaid coverage through the ACA might influence whether mentally ill adults could get needed care.

“There is overwhelming evidence that untreated mental illness impacts people’s jobs and performance in school, which in turn influence their ability to access health care,” said Dr. Joseph Puyat of the Center for Health Evaluation and Outcome Sciences at the University of British Columbia.

“Even when access is provided for by publicly-funded insurance coverage, people with untreated mental illness face challenges adhering to their treatment,” Puyat, who wasn’t involved in the study, said by email.

At the same time, dealing with the complexities of the U.S. health care system can prove daunting for people with mental illness, said Benjamin Cook, director of the Health Equity Research Lab at Cambridge Health Alliance and a researcher at Harvard Medical School.

“Some with symptoms of depression have a very difficult time mustering up the energy to leave the house, so you can imagine how difficult it is to generate the motivation to understand and navigate the complicated healthcare system,” Cook, who wasn’t involved in the study, said by email. “For others, seeking medical care raises anxiety and exacerbates symptoms.”

SOURCE: Psychiatric Services, online April 17, 2017.