July 30, 2019
Ann Arbor, MI — More than 650,000 Michiganders with a mental illness and over 500,000 with a substance use disorder fail to receive any treatment for their conditions, according to a new study by Altarum, a nonprofit health care consulting institute, which examined access to behavioral health services in Michigan by payer type.
Populations with the highest share of individuals going untreated for a mental illness include the uninsured (65 percent) and Medicaid enrollees (49 percent), while populations with the highest share of people going untreated for a substance use disorder include the privately insured (87 percent) and Medicare Advantage enrollees (80 percent).
The study was commissioned and funded by the Michigan Health Endowment Fund to better understand the current state of access in order to address gaps in care amid rising rates of behavioral health-related conditions in Michigan and across the United States, especially among young adults.
Behavioral health conditions that are most prevalent among Michiganders are also the most likely to go untreated. For instance, 46 percent of people with anxiety disorders, 53 percent of people with depressive episodes, and 85 percent of people with alcohol use disorders are not treated for their conditions.
The report defines treatment as receiving any care at all, and not necessarily what may be considered the appropriate type and volume of care for the condition. The assessment was conducted using administrative claims data from 2016. Details on data sources and methods are documented in the full report.
Michigan, like most of the country, has a shortage of psychiatrists and other behavioral health providers. Central Michigan has the largest share of untreated individuals with a mental illness (41 percent) and West Central Michigan the largest share of untreated individuals with a substance use disorder (83 percent). Altarum’s analysis shows that shortages of psychiatrists and other behavioral health providers are especially concentrated in the northern half of the lower peninsula and parts of the upper peninsula. Additionally, Michigan has 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 health care 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. This research characterizes the unmet need and provides insight into strategies likely to be effective in closing the gap in behavioral health care” said Emily Ehrlich, director of Altarum’s Center for Behavioral Health.
The study authors recommend a near-term goal of achieving the state’s best level of access—defined as having the smallest share of currently untreated individuals—for all regions across the state. In such a case, an additional 236,400 residents would receive mental health services, and an additional 87,500 would receive substance use disorder services.
The report contains 15 strategies for achieving best-level of access across the state that address the barriers of provider shortages, affordability, and patient willingness to seek care. The six top recommendations are 1) increasing retention of behavioral health providers in Michigan, 2) removing restrictions on the scope of practice to fully leverage all members of the health care team, 3) using lay providers such as peer support specialists, 4) using telemedicine to reach people in rural areas those unable to travel, 5) expanding access to services in schools, and 6) integrating primary care and behavioral health care delivery.
“This report provides a critical baseline for understanding and improving behavioral health care access in Michigan,” said Health Fund Program Director Becky Cienki. “We now have a clearer picture of the gaps and barriers to treatment, and we'll use the insights and recommendations from this study to guide the Health Fund's grantmaking strategy.”
Altarum will hold a webinar on August 8, 2019, to present the findings of this study and to answer questions. Policymakers, health officials, providers, social services professionals, nonprofit administrators and others who work in the area of behavioral health are encouraged to attend. Register for the webinar here, and read the full report.