Access to Behavioral Health Care Remains a Challenge in Michigan

As mental illness in Michigan increased between 2016 and 2019, treatment rates also increased, leading to a modest improvement in access but large gaps remaining.

December 13, 2022

Ann Arbor, MI — A new report from Altarum finds that access to mental illness and substance use disorder treatment remains a critical issue in Michigan. Funded by the Michigan Health Endowment Fund, the report provides an update to Altarum’s comprehensive assessment of access to behavioral health care across the state using data for calendar year 2016. Using data for calendar year 2019, the new report provides a picture of access just prior to the pandemic—providing a valuable baseline for future study.

Lack of access can result in unmet needs, delays in care, financial burden, and reduced health and wellbeing. The study examines 2019 administrative claims data for Michiganders covered under private insurance, Medicaid, or Medicare. Access is the percentage of individuals with behavioral health needs who received at least one instance of treatment in the year of study. While this does not account for the quality or completeness of care Michiganders receive, the results provide an updated picture to quantify any changes since 2016.

One key finding of the report was a modest improvement in behavioral health access—tempered by rising prevalence. Between 2016 and 2019, the number of individuals reporting any mental illness (AMI) in Michigan increased, but access to care also improved. Of the nearly 2 million Michiganders reporting AMI in 2019, 68 percent received treatment, leaving 32 percent untreated. This compares to 2016 estimates of 1.76 million Michiganders reporting AMI and 38 percent untreated.

The updated report also finds that most Michiganders with a substance use disorder (SUD) continue to go untreated. Of the 650,000 Michiganders with a SUD in 2019, 28 percent received treatment, leaving 72 percent untreated. This compares to 2016 estimates of 638,000 people with SUD and 80 percent untreated.

In both 2016 and 2019, access to AMI and SUD treatment varied considerably geographically within the state. For example, the share untreated for AMI ranged from 20% to 46% across metropolitan areas.  Behavioral health provider capacity was especially low in the northern half of the lower peninsula, where four counties have no psychiatrist, no psychologist, and no SUD treatment facility. Expanding access to behavioral health care in all of Michigan to the same rates of care seen in the best access areas of the state would improve access for 336,000 people with a mental illness and 85,000 people with a SUD.

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The new analysis adds more detailed information on behavioral health care utilization, including for particular populations. Highlights of these additional analyses included the finding that 31 percent of Medicaid enrollees being treated for opioid use disorder received medication assisted treatment (MAT), slightly higher than the national rate of 27.8 percent estimated in recently published research. In examining a new subpopulation—women who were pregnant or gave birth in 2019— we find that 26.4 percent of women covered under Medicaid and 45 percent of women covered under commercial insurance were screened for maternal depression during pregnancy or after birth.

“Altarum’s initial report provided a benchmark for identifying gaps to understanding and improving behavioral health care access in Michigan,” said Michigan Health Endowment Fund Director of Behavioral Health Becky Cienki. “The updated analysis expands this to new subpopulations, such as children in the foster care system and pregnant women, and provides a new benchmark for future comparison to post-pandemic behavioral health needs and access.”

The Covid-19 pandemic exacerbated the need for behavioral health services and inspired innovations that offered solutions to address barriers to access. The two reports, which use data from 2016 and 2019, provide purposeful, pre-pandemic baselines that can be used for future analysis of the pandemic timeframe.

“Based on our measures, pre-pandemic progress was being made in utilization, services provided, and the number of providers,” said co-author and Altarum Health Economics and Policy Research Director Corwin Rhyan. “But in addition to its impact on individual’s mental health and substance use behaviors, Covid-19 dramatically changed the way people receive behavioral health care, for example, accelerating the adoption of telehealth. It will be important to see how pandemic impacts play out in the coming years.”

Join the authors of the report and behavioral health experts for a webinar on January 10, 2023, at 1:00 pm ET, to discuss the findings of the study. Learn the details on what has changed in the Michigan landscape and what remains consistent from the first study published in 2019.  View recording of this webinar.

Altarum is a nonprofit organization that works with federal and state agencies and foundations to design and implement solutions to improve the health of individuals with fewer financial resources and populations disenfranchised by the health care system. We achieve measurable results by combining our expertise in public health and health care delivery with technology, workforce training and continuing education, applied research, and technical assistance. Our innovative solutions lead to better health for beneficiaries and better value for payers.