Mental health advocates in California, Rhode Island, and Oregon also say they're seeing greater demand for behavioral healthcare services by Medicaid enrollees.
Fellowship Health Resources, which runs mental health facilities in several states, has seen increased demand for behavior healthcare and substance abuse services. But CEO Debra Paul said the increase may have nothing to do with the Patient Protection and Affordable Care Act. “The increases are due to both increased awareness of behavior health and substance abuse issues coupled with economic impact such as poor job markets, and difficulty finding affordable housing,” she said.
By 2016, 2 million previously uninsured people between the ages of 18 and 64 will receive behavioral healthcare services under ACA, HHS' Substance Abuse and Mental Health Services Administration estimated in May. Of those people, 1.2 million will be Medicaid eligible, and the other 800,000 will have enrolled in an Obamacare exchange plan.
But states have reduced their mental health spending by $4.35 billion between 2009 and 2012, according to National Association of State Mental Health Program Directors. These cuts could limit access for newly insured people seeking care.
“We are receiving an incredible increase in calls asking for advocacy to help get into mental health treatment,” said Chaz Gross, executive director of the Rhode Island chapter of National Alliance on Mental Illness (NAMI). “We used to be able to make that happen in most cases. But now there just are not resources left to direct folks towards.”
Chris Bouneff, executive director of NAMI Oregon, said “we are receiving more reports of longer wait times for initial appointments at some of our larger nonprofit mental health providers. Medicaid recipients seeking mental health services have been restricted to small provider panels. And the influx of new members appears to be exacerbating that problem.”
Advocates hope that the Affordable Care Act's expanded Medicaid coverage for millions of low-income adults will prompt states to invest more money in mental health services, particularly for prevention and early intervention. This, they say, will save money down the line.
There also are concerns about a shortage of qualified mental health professionals to care for all the new patients seeking behavioral services as a result of the Affordable Care Act. The number of new psychiatrists entering the market continues to drop. Between 2000 and 2008, there was a 14% decline in graduates from psychiatry training programs, according to a Health Affairs article this month. On top of that, more than half of all psychiatrists are now 55 or older.
A side effect of the shortage of mental health providers is that many patients are seeking care for mental health issues from their primary-care providers. More than a third of patients who receive treatment for mental health disorders rely solely on primary-care physicians, according to a 2010 report from the Center for American Progress .
That brings its own problems. Patients “are prescribed drugs but are not getting psychotherapy,” said Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors.
The services patients receive through their primary-care providers are generally adequate because most of these patients are dealing with relatively minor conditions, he said. But advocates worry about whether the training of staffers in mental health centers is adequate.
“It is not unusual for mental health organizations to employ case managers with no more than a bachelor of arts degree, and sometimes less, and give them responsibilities for some of the most impaired patients,” David Mechanic, a Rutgers University health policy professor, wrote in the Health Affairs article. “If the United States is to truly move toward a safer and more effective and responsive system, it will be necessary to remake the behavioral health workforce; to train for more standardized evidence-based practices.”