More than one in five American adults battle depression, bipolar disorder, or some other mental illness. And even with insurance, about two-thirds of those patients can't access treatment.
That's because insurers are openly disregarding federal law and structuring plans that provide inadequate coverage for mental health care. These barriers especially harm patients of color, who disproportionately experience mental health challenges.
Federal law requires insurers to provide equal access to mental health conditions and physical health problems. But insurers have found ways to skirt those requirements.
Consider how many insurers set reimbursement rates for mental health services so low that providers struggle to sustain their practices. As a result, many mental health providers don't take insurance -- about a third of psychologists, for example, don't accept insurance.
That leaves patients with far fewer in-network options, often forcing them to pay out of pocket or go without care. In general, patients go out of network to see a psychologist 10 times more often than to see a medical or surgical clinician.
Even patients who do find in-network providers face coverage barriers.
For example, insurers frequently rely on "prior authorization," which requires doctors to complete lengthy paperwork and jump through administrative hoops to obtain insurer approval to prescribe a medication or treatment for a patient. Over a quarter of patients who take or seek a prescription medication for a mental health condition experience prior authorization issues, according to one recent survey.
Over 90% of doctors say that prior authorization delays necessary care, and over three in four say that patients discontinue treatment because of prior authorization challenges. Studies show that prior authorization can delay access to essential behavioral health medication, leading to decreased treatment effectiveness and avoidable harm.
I've experienced these delays firsthand. While living with bipolar disorder for more than a decade, I've had to navigate complex medication regimes and constant changes in treatment. A few years ago, prior authorization blocked me from getting the medication that kept me stable. This wasn't about my doctor's judgment, it was an administrative barrier that put my health at risk. If I can still face coverage gaps despite having resources and experience navigating the system, many others -- especially people of color -- are likely facing even greater barriers.
Prior authorization can also limit patients' access to other care and therapy they need, such as psychological testing, detox admissions, residential treatment programs, or hospital admissions for mental health care. In many cases, delays are only the first hurdle patients face.
Insurers also rely on "fail first" tactics, essentially requiring patients to try cheaper treatments or therapies before insurers will cover more effective, but more expensive, ones.
Many insurers even effectively impose limits on how many therapy visits a patient can have covered in a year or only offer mental health services for a limited amount of time. One ProPublica investigation, for example, found that UnitedHealthcare often flagged patients who received frequent "unwarranted" treatment. UnitedHealthcare allegedly flags up to 10% of cases. The insurance giant then contacts providers to deny coverage or pressure them to cut off therapy for patients -- many of whom desperately need care.
These practices harm all Americans, but they're especially damaging for communities of color. These communities are more likely to experience certain mental health challenges and less likely to receive care. It's already difficult for many patients of color to find providers who understand their background and experiences. Insurers' restrictions only exacerbate the problem.
We can fix this system, but only if we put patients and NOT profits at the center of care. Policymakers must ensure patients can access prescribed medications without dangerous delays, especially for chronic conditions where medication adherence is critical. They should also hold insurers accountable for overriding doctors' decisions.
Patients shouldn't have to wait for systems to catch up with what the law already guarantees. Access to mental health care must not hinge on red tape, delays, or arbitrary denials. Until insurers uphold both the letter and the spirit of the law, true access will remain more of a promise than a reality. It's time to shift from compliance to accountability -- and to replace barriers with genuine access to care.
Guy Anthony is the president and CEO of Black, Gifted & Whole.
