Mental Healthcare Disparity by Gender in the US

“Americans wait 11 years, on average, between onset of mental health symptoms and first receiving treatment. This gap is staggering.”- U.S. Surgeon General Dr. Vivek Murthy’s statement in a Senate Committee on Finance hearing on youth mental health.

Dr. Vivek’s statement is staggering for any nation like US, which is known for a perfect place about human rights and opportunities. But a recent study has shown that there is a slight healthcare disparity by gender in the country. Patient’s access to mental healthcare is lower among women than men. According to the Kaiser Family Foundation (KFF), limited provider availability and high costs are making it difficult for women to access mental healthcare.

Donut Chart

Mental Healthcare Access by Gender

The above data from the National Center for Health Statistics also shows that across all age groups, women are almost twice as likely to have depression and anxiety than men. However, only a smaller proportion of these women attempt to access mental healthcare compared to men.

“Women experience several mental health conditions more commonly than men, and some also experience mental health disorders that are unique to women, such as perinatal depression and premenstrual dysphoric disorders that may occur when hormone levels change,” the KFF researchers said.

According to the data, only half of the women ages 18 to 64 included in the KFF analysis thought they needed mental health treatment, yet just 60% sought it. Of those seeking mental healthcare, half got an appointment within a month, a quarter waited one to two months and 13% had to wait two months. This means that healthcare disparities based on gender are real.

Mental Health Stats of US Citizens

A number of studies have found that more than half of people who need mental health care do not receive it. 63% of Black adults, 65% of Hispanic and Latino adults, 80% of Asian and Pacific Islander adults do not get care when needed. Limited English proficiency can also be a barrier to accessing behavioral health care.

Black Adults 63%
Hispanic & Latino Adults 65%
Asian & Pacific Islander Adults 80%

Opioid overdose deaths among racial and ethnic minorities are higher than those of other racial or ethnic groups, according to a study by the National Institute on Drug Abuse (NIDAA). The study also finds higher rates of behavioral health conditions in LGBTQ populations and adolescents and young adults.

Consequences of Mental Health Disparity

According to a report by United States Senate Committee on Finance in March 2022, stigma, cultural attitudes and beliefs, insurance coverage, and lack of diversity in the mental health workforce are contributors to potential drivers of the gaps in care for racial and ethnic minorities. Suicide attempt rates are decreasing among White children, however, suicide attempts for Black children have increased by 73%. Asian American children may have higher unmet mental health needs, compared to White children.

Limitations in Medicare and Medicaid coverage and payment may contribute to access to care barriers among racial and ethnic minorities. Black, Hispanic, American Indian/Alaskan Native, and Native Hawaiians and Other Pacific Islander nonelderly adults are more likely to have Medicaid or other public coverage.

Impact of COVID-19 on Mental Health

Credits: cdc.gov

The first year of the COVID-19 pandemic saw an increase in the prevalence of mental health conditions, as well as the severity of those in crisis. Emergency department visits for overdoses and suicide attempts are 36% and 26% higher, respectively, compared to the same time period in 2019. Mental health providers have reported increasing demand with decreasing staff sizes.

Youth mental health worsened during the pandemic as children and adults faced unprecedented challenges. Depressive and anxiety symptoms have doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing symptoms of anxiety. ED visits for suspected suicide attempts were 51% higher for adolescent girls in early 2021 compared to the same period in 2019.

Mental Health Challenges

Mental health challenges vary across subpopulations, but boys are more likely to die by suicide or be diagnosed with a behavioral disorder. One study found that 42% of LGBTQ youth had considered suicide in the past year. Children who have experienced adverse childhood experiences are at greater risk for mental health and SUD conditions.

Barrier in Mental Healthcare Access

While provider availability (33%) and cost of care (33%) were the most common reasons holding women back from mental healthcare access, according to the researchers, 60% of those without insurance coverage said cost was a barrier. Another 8% said appointment wait times were unreasonable, 6% said they couldn’t find a provider nearby, and 6% said they were too busy or could not get time off from work. 4% said they worked through their problems on their own and 4% said the stigma around mental healthcare access deterred them.

Barrier in Mental Healthcare Access

In addition to this, 2 in 10 women said their provider did not accept their insurance and 3% of these women paid their entire bill out of pocket. Around half said their insurance company paid for part of their visits, and they paid the rest out of pocket, while 38% said their insurer paid the bill in full.

Legislative Regarding Mental Health

Mental health and substance use disorders (SUD) are covered in private insurance, Medicaid, CHIP, and Medicare, but gaps persist in coverage. Methadone and buprenorphine access is limited, as providers must obtain an X-waiver to prescribe these medications. In 1996, the Mental Health Parity Act eliminated annual or lifetime dollar limits on mental health benefits. This chapter summarizes the legislative history of mental health parity laws, parity enforcement, and potential challenges or gaps in coverage for such services.

Mental health and substance use disorder (MH/SUD) services have been covered on par with medical and surgical insurance since 2008. The Affordable Care Act (ACA) expanded the applicability of MHPAEA to individual market plans and certain small group market plans, as well as Medicaid alternative plan (ABPs) coverage. In 2018, a new act required states with CHIP programs that provide MH or SUD benefits to comply with parity requirements, and expanded telehealth services in Medicare.

Telehealth – A Potential Solution

The KFF researchers found that telehealth could be a potential solution for improving mental healthcare access. Of the 60% of adult women who had used telehealth in the past two years, 17% said it was for a mental health visit. Notably, telehealth was more common among rural dwellers, young women, and those with Medicaid coverage.

In response to the COVID-19 pandemic, many health care providers shifted their in-person practices to telehealth modalities. Telehealth enables patients and providers to connect with one another in multiple settings, including at home, in a clinic, or in a community facility. Patients can access behavioral health care services, such as psychotherapy, counseling, substance use treatment, and suicide intervention via telehealth.

Telehealth modality may reduce barriers to behavioral health care because it could reduce stigma associated with accessing mental health and SUD services. Some commenters noted that audio-only telehealth services limit a clinician’s ability to perform certain physical behaviors. RFI commenters also noted that state licensure laws sometimes limit access to tele-behavioral health care.

Even though telehealth is helpful, it is only effective when patients’ insurance covers a virtual mental health visit. Seven in 10 women who had accessed both in-person and telehealth mental healthcare said quality was about equal.

US Government’s Efforts to Make Telehealth Accessible to All

Prior to the COVID-19 PHE, telehealth services had to be delivered to beneficiaries who were located in a qualified “originating site,” such as a clinician’s office or hospital. Certain services had been made eligible for telehealth regardless of urban or rural location. For example, HHS and CMS temporarily waived the geographic and originating site restrictions for all covered services so that urban and rural patients could receive telehealth at home.

Now, the $1.7 trillion spending bill Congress unveiled this week includes an extension of HHS rules that made telehealth more accessible during the COVID-19 pandemic. Telemedicine groups cheered the legislation, while still reminding lawmakers there’s more to do. Before the bill, telehealth use in Medicare was restricted to specific locations and circumstances, like rural areas or patients already in hospital.

The American Telemedicine Association spent $120,000 in the third quarter alone, four times higher than its spending at the same time last year. The ATA lobbied as lawmakers considered what to include in the omnibus spending bill. And the omnibus is expected to be sent to President Joe Biden to be signed into law within the next week.

Conclusion

As concluded by the KFF researchers, future policies affecting telehealth, provider availability, health insurance coverage, and affordability will play a significant role in addressing the demand for mental health care for the US citizens. In a country who sincerely advocates equality and equal opportunity for all of its citizens, healthcare disparity by gender, or race, or of any other kind, creates a loophole for negatively unique criticisms. Everybody knows how vital is a person’s mental health. And only by increasing access to mental healthcare, all genders, races, as well as colors can receive the care they deserve.