Access to Care - 
Mental Health and Substance Use Treatment

Definition

Mental health care is a range of treatments that focuses on the well-being of the mind. This care ranges from prevention to treatment of mental illnesses. 

Substance use treatment is a range of care that focuses on the impact substance use has on an individual’s well-being. This care also ranges from prevention to the treatment of substance use disorders.

This topic focuses on an individual’s ability to access needed mental health and substance use treatment services. 

There is a unique set of challenges that impact an individual’s ability to access needed mental health and substance use treatment services. Individuals often have greater difficulty overcoming these challenges when trying to access needed mental health and substance use treatment services compared to physical health care services. Access to mental health and substance use treatment services is influenced by many factors, including:

• availability of providers, treatment centers and resources,
• affordability of services,
• insurance coverage,
• screening and referral practices,
• an individual’s ability to recognize the symptoms of mental health or substance use issues, and
• social stigmas around mental health and substance use (1,2,3).     

Implications and Data for Jefferson County

Community Health Needs Assessment Focus Group Findings

Participants had concerns around the prevalence of mental illness in the community and its interconnection to substance use. They also expressed a desire for information on where to access mental health and substance use treatment in both urban and rural areas in Jefferson County. Some participants wished to have services closer to home or through the school for their children. 

In the chart above, 15.8 percent of those five years and older in Jefferson County did not receive needed mental health care. The chart below looks at that those who did not receive needed mental health care in more detail from 2013 to 2019.  For example, among those less than 40 years of age, the percent not receiving needed care has been increasing over time. Due to the introduction of the Affordable Care Act, the number of people without health insurance in Jefferson County has decreased. As a result of the small number of people who are uninusured, we are unable to report on needed mental health care after 2013. However, by looking at 2013 data, where 30 percent of those who were uninusured needed but did not receive mental health care, it is probable that those who remain uninsured in Jefferson County are less likely to receive needed mental health care. In addition, those who are at or below the poverty level, consistently have a harder time receiving needed care than those above the poverty level.

In Jefferson County, 15.3 percent of those ages 5 and older did not get needed mental health care OR substance use treatment in the past year. The chart below shows the reasons why Jefferson County residents report they did not receive the care they needed. In this chart, substance use treatment was combined with mental health care data to create more reliable estimates of the reasons why our residents are not receiving services.

Community Health Needs Assessment Key Informant Findings

Key informants relayed seeing a rise in the incidence of mental illness or referrals through their organizations in the last few years. Many key informants noted that some individuals are coping not only with mental illness, but substance misuse, chronic diseases, food insecurity, poverty and homelessness. One informant expressed the need to have wrap-around services for these individuals. Many key informants reported that individuals receiving mental health treatment are often in need of substance misuse treatment as well. An informant serving people with disabilities noted that mental illness prevalence is just as high among people with disabilities as those without disabilities, with suicide being a significant concern. Informants noted that Medicaid reimbursement rates are too low for mental health and substance use treatment providers. This impacts their ability to provide extended services and capacity to the community. Specifically, some informants noted the reimbursement they receive from Medicare and Medicaid is too low for the actual expenses incurred, and this also makes outside referrals difficult as existing providers are at capacity for this payer.

One informant noted more attention needs to be paid to proactive treatment and prevention efforts that address the symptoms of mental illness before they worsen. Currently, the most severe cases are addressed most often.

Greater integration of behavioral health in primary care settings, coupled with efforts to reduce stigma of mental illness and increase awareness, was noted as a need by one informant. 

The charts below show the percent of women in Jefferson County and Colorado who had a discussion with their doctor, during their prenatal care visits, about what to do if they became depressed during or after pregnancy. This is an intervention that is intended to increase mental health care utilization and access to pregnant and postpartum women.

In Colorado, about 95,000 adults (2.3 percent) needed substance use treatment, but did not receive that care in the past year. The data below shows the reason that 2.3 percent did not access needed treatment.

Health Disparities and Inequities

A recent study evaluating trends in access to mental health care for three racial/ethnic groups in the U.S. found that African Americans, Asians and Hispanics were less likely to access mental health care than their white counterparts, with Asians being the least likely to access mental health care (4). The data available on racial/ethnic disparities for access to mental health care in Jefferson County in limited. However, disparities in access to mental health care do exist in Jefferson County based on age, income and type of health insurance.  

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Reference List

1. Healthy People 2020 (2018, May 30). Mental Health and Mental Disorders. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders

2. Wilson, W., Bangs, A., Hatting, T. (2015, February). The Future of Rural Behavioral Health [Issue Brief]. Retrieved from: https://www.ruralhealthweb.org/NRHA/media/Emerge_NRHA/Advocacy/Policy%20documents/The-Future-of-Rural-Behavioral-Health_Feb-2015.pdf

3. L’Hote, E., Fond., M., Volmert, A. (2017, August). Beyond Awareness of Stigma: Moving Public Understanding to the Next Level. Retrieved from: https://www.frameworksinstitute.org/assets/files/mental_health/TCHD_MentalHealth_MTG_FINAL.pdf

4. Lê Cook, B., Trinh, N., Hou, S., Progovac, A. (2017). Trends in racial-ethnic disparities in access to mental health care, 2004-2012. Psychiatric Services 68(1):9-16. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/27476805 

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Data Sources

CO BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey: http://www.chd.dphe.state.co.us/cohid/

CHI CHAS: Colorado Health Institute, Colorado Health Access Survey: https://www.coloradohealthinstitute.org/data

Colorado Dept of Regulatory Agencies, 2017 Licensure Data via Colorado Health Institute: https://www.coloradohealthinstitute.org/data

PRAMS via CDPHE: Pregnancy Risk Assessment Monitoring System via Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/cdphe/vision-data-tool and http://www.chd.dphe.state.co.us/cohid/Default.aspx

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Published on July 17, 2018

Updated on February, 25, 2020