May is Mental Health Awareness Month, providing a renewed opportunity to reflect on how to improve the delivery of behavioral health care, especially as the COVID-19 pandemic has exposed how millions across the country struggle with mental health and substance use disorders (SUDs). Insights from Mathematica’s work for the Centers for Medicare & Medicaid Services and the Office of the Assistant Secretary for Planning and Evaluation can guide decisions about future policies and investments to address behavioral health needs in communities. Recent findings include the following:
- Use of services for mental health and SUDs declined substantially among Medicaid and CHIP (Children’s Health Insurance Program) beneficiaries during the COVID-19 pandemic, at a time when preliminary evidence shows that these conditions have worsened nationwide. Although the data show usage rates for certain services have recovered or started recovering to pre-pandemic levels, many Medicaid and CHIP beneficiaries have not gotten the care they have needed during this pivotal period. Mathematica also support the production and publication of the Transformed Medicaid Statistical Information System SUD Data Book, which shows that before the pandemic, 4.6 million Medicaid beneficiaries ages 12 and older (or 8 percent of these beneficiaries) were being treated for an SUD. This decline in use affects millions of individuals.
- The United States has made progress in reducing SUDs among adolescents and young adults, but rates of these disorders among adults ages 26 and older have remained constant or increased over time. These findings indicate that more attention is needed to focus substance use interventions on adults in their prime working years.
- Recent efforts to improve access to treatment for opioid use and other SUDs have increased access to care in private doctors’ offices and specialty treatment facilities. There has also been a substantial increase in the use of medication-assisted treatment for opioid use disorder. However, the number of individuals who receive substance use treatment remains far lower than population-based estimates of need.
- The behavioral health system does not have the capacity to provide treatment to everyone who needs it. Several findings—including rising numbers of young adults with perceived unmet mental health care needs, high usage rates for inpatient and residential beds, and poor follow-up care after psychiatric hospitalizations—indicate gaps in the system. Expanding treatment capacity will likely require an increase in the number of behavioral health professionals in the workforce and innovative approaches, such as telehealth services and mobile applications. National and state-specific findings on treatment demand and provider capacity for mental health and SUDs are available in a comprehensive chartbook.
- Increasing the role of psychiatric nurse practitioners and further investments in mobile applications and crisis services could increase access to behavioral health care and address longstanding workforce capacity issues. However, some changes to policy and funding are necessary to support these solutions. In addition, there is a need for more awareness of crisis services and stronger links between crisis services and other community providers.