Access to Care

Ron ManderscheidRon Manderscheid, Ph.D.
Executive Director, NACBHDD

If you or a family member needed care today for a mental health or substance use condition, would you be able to get it? Mental health and substance use conditions, like depression or inappropriate use of alcohol, are real, treatable health problems. As with other health problems (like diabetes, high blood pressure, or heart disease), people with mental or substance use conditions can lead healthy, productive lives when the health problem is diagnosed and treated. When identified and treated early, the severity and impact of these health issues, including damaging consequences to both the person being treated and her or his family, can be reduced. That’s why the process of getting care—what we refer to as gaining access—is critically important.


Access to care can help prevent, delay, and treat mood disorders, other mental health conditions, and co-occurring illnesses, such as substance use. Having access to mental health care services can be the factor that determines whether a person is able to achieve wellness or succumb to despair, restore a healthy relationship or divide a family, keep a job or become dependent on family or government subsidy. Having access to mental health care services affects most if not all of us at some point in our lives and that’s what makes this topic worthy of being the inaugural blog post on Care for Your Mind.

Over the past few years, a growing number of lawmakers have recognized that mental health is part of overall health. They decided it was time for both public and private health plans to

  • End annual and lifetime limits on behavioral health coverage
  • Make out-of-pocket costs for mental health and substance use care no more expensive than for medical care
  • Stop penalizing people with existing mental or substance use conditions and stop restricting them from getting health coverage in the first place.

Recognition became reality when Congress enacted the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to assure that people with mental health or substance use problems are not denied health care based solely on that diagnosis. In this realm, parity means assuring access to health care services for mental health conditions on par with physical health conditions. This commitment to parity for mental health and substance use conditions is being implemented across the nation as the preventive and integrated care provisions of the Affordable Care Act (ACA) take effect.

At last, mental and addictive health are beginning to be treated as part of overall health. And it’s about time! After all, these conditions are among the top causes of disability in the US and worldwide. They take a toll on families, communities, the education system, the workplace, and the economy to a startling degree.

Facts, Just the Facts
The numbers tell the story.

  • Mental disorders affect 1 in 4 US adults (45.6 million) and children/youth (15.6 million)
  • Mood disorders affect 20.9 million American adults age 18 and older (that’s 9.5% of the population), and are more prevalent in women than in men, affecting girls age 12 to 15 at triple the rate as in women (15.2% for girls and 5.1% for women)
  • As many as 8 million adults age 18 and over have both a mental and a substance use condition: rates of substance use disorders among people with mood disorders are double those of other adults. 

These data point out a cold, hard truth: access to care is critical for millions of people of all ages. Both health and life can be affected for better or for worse by the ready availability of care. However, the realities of access are that fewer than 40% of adults and youth with mental health conditions ever get any mental health services fewer than 7% of adults with co-occurring mental and substance use disorders get treatment for both; 32.5% receive only mental health care and 4% get only substance use treatment.

The Importance of Access to Care
When access to care for any chronic health problem, including mental health conditions and substance use disorders, is—or care for any other chronic health problem—is denied or otherwise unavailable, prevention and early intervention are all but impossible. Symptoms go unmanaged and get worse. Without diagnosis and treatment, people get sicker faster. For many people with treatable mental or substance use problems, the result can be a downward spiral of increasing disability. Many experience additional physical or behavioral health problems that also may go untreated. Without diagnosis and treatment, the lives of people with mental or substance use conditions may be cut short by as many as 25 years. That’s a lot of living to lose! But the toll doesn’t stop there: this downward spiral often includes lost education, lost employment, broken families, and, too often, lives lost to suicide.

In contrast, available and accessible care is based on the recognition that care for mental health and substance use problems is part of overall health care, and that these conditions are real and treatable. Addressing them as treatable medical conditions can reduce the negative perceptions — or stigma — associated with mental health and substance abuse conditions, much like the change in how the public looks at cancer. That’s good public health policy.

Accessible mental health and substance use care is also good personal health policy. Access to evaluation and diagnosis can help prevent or delay the onset of these conditions. Access to early intervention can move people with diagnosed mood disorders and other mental health conditions toward health and recovery. Related health problems, such as substance use or alcoholism, heart disease, and HIV, also can be delayed or prevented altogether. That’s not only for medical reasons, but also because access to mental health and substance use care as part of overall health care involves creating links to all kinds of helpful services and supports that encourage community engagement and integration. And those services and supports can help boost protective factors that promote ongoing mental and physical health and reduce risk factors for the recurrence of mental or other health problems.

Ongoing access yields an opportunity for patients and health care professionals to examine how well care and treatment are going and to make collaborative decisions about needed changes. Ultimately, ongoing access makes the promise of recovery a reality.

Editor’s Note:
Ron’s next contribution to Care for Your Mind explores major obstacles to access. The third explains how the Affordable Care Act helps improve access to mental health care for millions of Americans, including you. Finding out that you or a family member has a mental health or substance use condition is only the beginning. Make comments, ask questions, and continue to learn about mental health care on Care for Your Mind.

Facebook Comments


  1. […] the May 1 “Access to Care” post, we asked, “If you or a family member needed care today for a mental health or substance use […]

  2. […] and Anticipating Impact Last week, Ron Manderscheid pointed out  the possible consequences of decreased access to mental health services: worsening of symptoms, an […]

  3. […] inaugural post Access to Care was written by Ron Manderscheid, PhD.  He’s the Executive Director of the National […]