Why Quality Mental Health Care for the Lower and Middle Class is Hard to Come By

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Mental health care is a prominent topic these days in the wake of the COVID19 pandemic. Many people are realizing they need treatment and are struggling to find care that fits their needs. Why is it so difficult for individuals and families to find care? What’s so difficult about getting proper mental health care? From my experience of working in the outpatient mental health care industry for over 7 years, and my personal experience in accessing mental health care, the answer is multi-layered and there is not an easy or simple fix. However, one common theme I’ve found throughout the healthcare system and is even more prominent in mental health care is privilege.

Most individuals in this country seek to use the health insurance they pay for in order to get treatment for various medical conditions. However, what is increasingly more common is that health insurance doesn’t cover what the cost an individual or family was expecting and/or the provider they want to use doesn’t accept their health insurance carrier. And sometimes this is found out after they have received the care. Why is this? Unless families have experience in the health insurance sector, they have difficulty understanding the ins and outs of their health insurance plans and rely on assumptions and the knowledge of the provider in order to tell them what the cost will be. Often times the providers relay information to the patient based on the knowledge they receive directly from the insurance company about the expected cost, but inevitably the cost ends up being much more than expected because of minute details in the health plan that the insurance company failed to convey to the provider and the patient didn’t understand because of the way health insurance plans explain the cost and benefits. So what happens when the patient can’t afford to pay the cost the insurance plan now reveals to them? They end up not receiving the care they need unless they can afford to pay out of pocket. 

Unfortunately, mental health care coverage and accessibility is much more difficult than what is considered regular medical care (i.e-physical illness). Unlike physical illness, the demand for mental health care is so high that most providers and organizations, even the big ones, can’t keep up. Providers and provider organizations that accept health insurance simply don’t have enough providers with clinically appropriate experience and space in their schedule to get all the people that are requesting care in to be seen. Why is that? Many outpatient mental health care providers don’t want to work for big hospitals and organizations and make the choice to go into private practice for the flexibility and convenience factors of working for themselves. This results is high turnover for the companies in the business of providing care that insurance covers, making it even more challenging for these companies to keep up with the demand. Not only do these companies then have to place the patients that choose not to follow the providers into private practice, but they are also still trying to place the patients still seeking care for the first time. Why don’t all the patients of the departing provider follow him or her? Unfortunately, many private practice providers decide not to accept health insurance and so patients are forced to find a new provider that does because they cannot afford to pay out of pocket. 

Why don’t more private practice providers accept health insurance? As detailed above, health insurance companies and patients’ health plans are very complicated and difficult to navigate. Unless the private practice provider has the time or resources to be able to spend time navigating this path, they often choose not to accept health insurance and exclude the patients that don’t have the financial resources to pay out of pocket or can wait to get reimbursed a fraction of what they are paying out of pocket through out of network benefits. This is compounded by the fact that unlike standard medical care for physical illness, insurance companies do not reimburse mental health providers enough for them to have a sufficient income let alone make ends meet. In order to get even a decent insurance reimbursement rate, a dedicated person or department in these mental health care organizations is dedicated to negotiating sufficient reimbursement rates. And even then, many times they are not successful and will choose not to accept certain insurances simply because the reimbursement rates are so abysmal. 

Privilege allows certain patients to get care because they have the financial resources to do so, and forces others to either not get care or get lower quality care. I don’t have the answers about how to fix this very broken system and I realize it’s a bigger issue than just mental health care. However, from my knowledge and experience, mental health care takes the brunt of the problem because of the nature of proper mental health care and health insurance companies, investors, and government organizations simply not prioritizing funding for the significant need. I think a starting point is to force health insurance companies to give better reimbursement rates to mental health care providers and organizations, make health insurance plans more affordable to individuals, families and employers, and make the ins and outs of insurance plans easier to understand for the greater population. Finally, hospitals and companies supporting mental health providers in this high burnout field is essential in preventing a shortage of providers and increasing the problem and demand even further. 


  • Sarah Rudman

    Healthcare Operations Manager

    I have 7+ years of experience working on the business side of the outpatient mental health care practices. I've worked with every aspect of the business from intake to insurance. I'm currently a healthcare operations manager for a mental health and ABA therapy organization.