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Mental health care remains inaccessible to many distressed. adults in U.S.

An increasing number of U.S. adults experienced serious psychological distress due to the COVID-19 pandemic, and outpatient mental health care remains inaccessible to many of them, a new study indicates. Photo by Andrew Neal/Pexels
An increasing number of U.S. adults experienced serious psychological distress due to the COVID-19 pandemic, and outpatient mental health care remains inaccessible to many of them, a new study indicates. Photo by Andrew Neal/Pexels

NEW YORK, Feb. 5 (UPI) -- An increasing number of U.S. adults experienced serious psychological distress due to the COVID-19 pandemic, and outpatient mental health care remains inaccessible to many of them, a new study indicates.

Published Monday in Annals of Internal Medicine, the study was conducted by the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center in New York City.

"The pandemic has taken a toll on the mental health of adult Americans," the study's lead author, Dr. Mark Olfson, a professor of epidemiology at Columbia Mailman School of Public Health, told UPI via email.

Meanwhile, insurance claims, mental health care provider surveys and electronic health records indicate that outpatient mental health visits declined during the acute phase of the pandemic, said Olfson, who also is the Dollard Professor of Psychiatry, Medicine and Law at the medical center.

Olfson said that "we undertook this study to describe in broad terms the effects of the COVID pandemic on the psychological well-being of adults in the United States and to evaluate the extent to which outpatient mental health care, including telemental health care, reached adults in need of mental health services during this period."

“The pandemic has taken a toll on the mental health of adult Americans,” said the study’s lead author, Dr. Mark Olfson, a professor of epidemiology at Columbia Mailman School of Public Health. Photo courtesy of Columbia Irving Medical Center
“The pandemic has taken a toll on the mental health of adult Americans,” said the study’s lead author, Dr. Mark Olfson, a professor of epidemiology at Columbia Mailman School of Public Health. Photo courtesy of Columbia Irving Medical Center

U.S. trends and patterns align with global reports concluding that several mental health problems, including depression and generalized anxiety disorder, have become more prevalent during the pandemic, Olfson said.

"Between 2018 and 2021, there was a significant increase in the percentage of U.S. adults with serious psychological distress. In response to increasing distress, a greater number of Americans received outpatient mental health care," he said.

"However, there was a decline in the percentage of adults with serious psychological distress who received care during this period. This suggests that more needs to be done to extend outpatient mental health care access to those in greatest need."

Researchers evaluated adult responses from the Medical Expenditure Panel Surveys by the Agency for Healthcare Research and Quality Component, a nationally representative survey of more than 85,000 people. Psychological distress was measured with a six-point scale range and computer-assisted personal interviews determined outpatient mental health care use.

The rate of serious psychological distress among adults rose from 3.5% to 4.2% from 2018 to 2021. Although outpatient mental health care also increased overall -- from 11.2% to 12.4% -- the rate among adults with serious psychological distress decreased from 46.5% to 40.4%.

Young adults (aged 18 to 44 years) had significantly increased outpatient mental health care, but not middle-aged (aged 45 to 64 years) or older adults (older than 65 years).

More employed adults reported outpatient mental health treatment than the unemployed. In 2021, 33% of mental health outpatients had at least one video visit.

The chances of receiving in-person, telephone, or video mental health care differed across sociodemographic groups. Percentages of video care were higher for younger adults than for middle-aged or older adults, women compared with men and college graduates compared with adults with less education.

Seriously distressed, lower-income, unemployed and rural patients has less chance of video care, as well.

"The study indicates that telemental health care is favored by young, urban, highly educated, affluent adults with private insurance," Olfson said.

But, he added, "In some sense, telemental health care has been a double-edged sword. While it has provided an important means of increasing access to outpatient mental health care, it has also posed obstacles to some groups in need."

Overcoming these challenges will require teaching people digital skills to operate video applications, developing subsidies for low-cost telehealth options that would serve low-income individuals and making public investments to ensure universal access to high-speed broadband, he said.

Dr. Mason Turner, a psychiatrist and medical director of behavioral health clinical programs at Intermountain Health in Salt Lake City, who was not involved in the study, told UPI via email that "the fact that those among us with the greatest distress are not receiving [mental health] care is extremely concerning."

Turner, who is an addiction medicine specialist, added that "the increase in service utilization among young adults is promising, though, and may indicate a gradual eroding of stigma in seeking mental health treatment."

However, he said, prescribing a one-size-fits-all approach doesn't address disparities. Providers shouldn't rely solely on telehealth to meet rural communities' needs -- they should understand "how to leverage different means of outreach and care." This would help "bring the benefits of treatment to all individuals."

Disparities persist as some elderly adults are uncomfortable with telehealth technology. Meanwhile, people from lower socioeconomic backgrounds may lack access to a telephone or a computer, and an individual with schizophrenia may feel uneasy being on video, Dr. Michelle DiBlasi, director of inpatient psychiatry at Tufts Medical Center in Boston, told UPI in a telephone interview.

"Now that the COVID-19 era is behind us, it makes sense to encourage more in-person options for patient care rather than relying on telehealth only," DiBlasi said.

Telehealth may not be the best way to treat adults with severe and persistent mental illnesses, which often require multifaceted care, including case and medication management as well as community involvement, said Allison Kranich, a licensed clinical professional counselor at Northwestern Medicine McHenry Hospital in McHenry, Ill.

Many distressed adults encounter difficulties accessing mental health care because "clinicians cannot keep up with the demand for services while protecting the quality of care and value of the therapeutic relationship," Kranich said.

"Wait lists are long despite clinicians and staff working overtime and doing all they can to support communities. At the end of the day, the demand is greater than the supply."

Mental health workforce shortages exist across the country, but are more profound in rural areas, said Dr. Jonathan Alpert, chair and professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine/Montefiore Health System in the Bronx, N.Y.

Inadequate insurance coverage for mental health services also hinders people from finding skilled providers who are in network with their commercial or public health plans, Alpert said.

"Many people cannot afford to get the treatments that would help them become more thriving and productive members of society," he said.