More than 650,000 Michigan residents with a mental illness and more than 500,000 with a substance use disorder aren’t receiving treatment, according to a new behavioral health access study from Altarum. That’s 38% of residents with any mental illness and 80% of those with a substance use disorder. The Health Fund commissioned and funded the study to better understand the state of behavioral health access amid rising rates of behavioral health-related conditions in Michigan and across the country, especially among young adults.
The report provides a clear picture of the gaps and barriers to treatment, as well as a baseline for understanding and improving access. The Health Fund will use the report and its recommendations to help guide our grantmaking strategy and evaluate whether our efforts are leading to better access for Michigan residents.
One revealing insight: the most prevalent behavioral health conditions are also the most likely to go untreated. 46% of people with anxiety disorders, 53% of people with depressive episodes, and 85% of people with alcohol use disorders are not receiving treatment for their conditions.
Additionally, populations with the highest share of individuals going untreated for a mental illness include the uninsured (65%) and Medicaid enrollees (49%), while populations with the highest share of people going untreated for a substance use disorder include the privately insured (87%) and Medicare Advantage enrollees (79%).
These numbers are alarming, but they don’t tell the whole story. The report defines treatment as receiving any care at all, which may not be the appropriate type and volume of care for the condition. Bringing these untreated people to care in some capacity is just the first step.
Barriers to care
So why are so many people who need treatment going without? One major reason: provider shortages. Altarum’s analysis shows that Michigan, like most of the country, has a shortage of psychiatrists and other behavioral health providers. Shortages are especially concentrated in the northern half of the Lower Peninsula and parts of the Upper Peninsula, including some counties without any psychiatrists at all. As a whole, Michigan has only 11 child and adolescent psychiatrists per 100,000 people, far short of the recommended ratio of 47 to 100,000.
The study also includes analysis of data from the 2016 National Survey on Drug Use and Health, which show that cost of care, lack of transportation, and public awareness and perceptions about behavioral healthcare are also barriers to access.
“Substance use disorders and mental illness have been on the rise in the United States and Michigan, and policymakers are looking for practical solutions,” said Emily Ehrlich, director of Altarum’s Center for Behavioral Health. This research characterizes the unmet need and provides insight into strategies likely to be effective in closing the gap in behavioral health care.”
Strategies for improvement
The report offers 15 strategies for improving access, addressing barriers like provider shortages, affordability, and patient willingness to seek care. Some of the key recommendations:
- Increase retention of behavioral health providers in Michigan
- Remove restrictions on the scope of practice to make full use of all members of the healthcare team
- Increase use of lay providers such as peer support specialists
- Expand implementation of telemedicine to reach people in rural areas and those unable to travel
- Extend access to services in schools
- Integrate primary care and behavioral healthcare delivery
The authors suggest a short-term goal of achieving the state’s current best level of access—defined as having the smallest share of untreated individuals—for all regions across the state. In such a case, an additional 236,400 Michigan residents would receive mental health services, and an additional 87,500 would receive substance use disorder services.
Still, that would leave too many Michigan residents going without treatment that could improve or even save their lives. The numbers are startling, and serious progress will require long-term commitments and systemic changes from stakeholders at all levels.—
The Health Fund’s Role
While we plan to use this report to help guide our future grantmaking, the Health Fund is already supporting a number of projects that fit squarely within the report’s recommendations.
School-based programs, a Health Fund priority, can provide behavioral healthcare access for children. For example, TRAILS to Wellness is developing a statewide network of coaches that in turn train school professionals on behavioral health practices in the school setting. A grant to the School Community Health Alliance of Michigan is helping to identify how financing for school health services can be sustainable in the long term.
Integration is already one of the Health Fund’s cross-cutting goals, and our grants support a range of efforts to better integrate primary and behavioral health services. In the Upper Peninsula, where behavioral health services can be scarce, Upper Great Lakes Family Health Services is working to combine the resources of two disparate organizations in order to provide comprehensive care to residents with substance use issues.
Health-related technology is also one of the Health Fund’s focus areas, and we’re investing in projects across the state to advance telemedicine. In Southeast Michigan, the Judson Center is using telepsychiatry to help more children in foster care receive assessment, medication review, crisis intervention and care.
We know that no single organization can address the various gaps and barriers to behavioral health services. That’s why we’re a partner in the Michigan Opioid Partnership, a collaborative of funders helping to expand access to medication-assisted treatment in crisis settings such as hospitals and jails.
Altarum’s study revealed just how far we have to go before every Michigan resident can access the care they need, but it also provided a road map for how to get there. We’ll continue working with other funders, as well as the private sector and government, to support promising innovations, expand successful practices across the state, and provide a pathway to access for everyone who calls Michigan home.
The full study, a toolkit, and various other resources can be found at mihealthfund.org/access.