Impact of insurance type on outpatient mental health treatment of US adults

The mental health treatment gap in the US continues to be a major public health challenge. Even individuals with health insurance face substantial barriers to care, including high costs, insufficient coverage and inaccurate provider directories. Policies to address the treatment gap require updated population-based information about whether treatment rates vary by type of insurance. The current study aimed to compare past-year outpatient mental health treatment across insurance types (private, Medicare, Medicaid, other, or none), in the household sample of non-elderly adults in the Mental and Substance Use Disorder Prevalence Study (MDPS), (n = 4,640). MDPS, fielded October 2020 through October 2022, identified 12-month prevalence of mental disorders and rates of treatment among US adults from interviews by trained clinicians using the Structured Clinical Interview for DSM-5. Logistic regressions estimated odds of treatment among participants with a past-year MDPS diagnosis across insurance types, after adjusting for age, sex, race/ethnicity, income level, diagnosis, and functional impairment. Analyses were weighted to reflect the US adult population. 60.2% of the 1,833 participants with an MDPS mental disorder received outpatient treatment in the past year. Compared to participants with private insurance, those with no insurance had lower odds of outpatient treatment (AOR = 0.37 [0.16-0.87]). Participants with Medicare had higher odds of treatment (AOR = 4.25 [1.56-11.64]), suggesting that individuals with complex and disabling illness were least likely to have treatment disruptions during the early phases of the pandemic. Differences between groups decreased as the pandemic progressed, but utilization of services only significantly increased among individuals with private insurance. Persisting mental health treatment gaps in the US vary by type of health insurance, which warrants extensive policy reforms.