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Mental and substance-use disorders, hereafter referred to as mental disorders, are major contributors to the burden of disease around the world.1 More than half of all Americans will have symptoms of a mental disorder at some point in their lives.2 Yet, persons with these conditions have historically faced limits on health insurance coverage that have restricted their access to treatment, along with shortages of mental health specialists (particularly those who accept insurance) and a treatment system plagued by fragmentation in care delivery. Such fragmentation stems from the historical separation of mental health providers from the rest of the health care system.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 — the federal law requiring parity in mental health and medical benefits — and the Affordable Care Act (ACA) of 2010, which extended the parity requirements of the MHPAEA and expanded coverage options, dramatically improved financial access to treatment for millions of Americans. Nevertheless, problems remain, and the quality of care is still often poor.3
In this report, we will cover issues that surround treatment for mental disorders, including the prevalence of mental disorders, spending trends, the shortage of practicing mental health specialists, efforts to break down the separation between mental health providers and the rest of the health care system, the impact of the MHPAEA and ACA, and the status of proposed federal legislation that seeks to address the shortcomings of the current mental health system.
Mental Health Treatment and Spending
Millions of Americans have symptoms associated with mental disorders each year, yet only a minority of such persons receive treatment for those conditions. On the basis of the latest survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 45% of some 43.6 million adults with any mental illness in 2014 received mental health services during the previous year, with only 69% of the approximately 9.8 million adults with a serious mental illness receiving services.4 Treatment rates for substance-use disorders (related to the use of alcohol, illicit drugs, or both) were even lower. Only 4.1 million Americans who were 12 years of age or older received treatment in 2014, whereas an estimated 22.5 million Americans in this age group had a substance-use disorder.5