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Geographic Disparities in Mental Health Access Highlight Challenges

Summary

Over half of counties in the US (52%) do not have any mental healthcare providers.

One of the largest barriers to Americans accessing needed mental healthcare is the lack of providers. While availability of mental health providers can vary depending on state, location in urban or rural areas, and insurance status, large swaths of the country have limited to no access to necessary mental healthcare.

As part of Avalere’s efforts around Mental Health Awareness Month, we conducted an analysis to identify areas with limited or no access to mental healthcare providers. Specifically, Avalere examined the availability of mental health providers in every county in the US to map where Americans may be facing barriers to necessary care. For purposes of this analysis, mental health providers were defined as psychiatrists, psychiatric hospitals, and Medicare-certified community mental health centers (CMHCs). The results are presented as ratios of population to mental health providers.1

Figure 1. Mental Health Provider Access by State, County, and Population Size

At the state level, mental health provider access is poor in the sunbelt and the mountain west. Texas (13,000 people per provider), Mississippi (13,000 people per provider), Arkansas (13,000 people per provider), Tennessee (13,000 people per provider), and Alabama (12,000 people per provider) all have population to provider ratios at the state level at or above 12,000. Similarly, in the mountain west, Idaho (18,000 people per provider), Nevada (15,000 people per provider), South Dakota (14,000 people per provider), and Utah (14,000 people per provider) have the lowest access to mental health providers.

Patients can have very limited access in a county even in states with seemingly greater access. Some counties in states such as Pennsylvania, New York, and Minnesota have more than 50,000 people per provider. Overall, half of the counties in the US (52%) do not have any of the 3 mental health provider types available, indicating large geographic disparities in access to mental healthcare, especially in rural locations.

Clearly, substantial progress is still to be made in ensuring mental healthcare access for all Americans. A combination of increased use of technology (telehealth), initiatives to ensure access to providers in more rural areas, integration of mental health with primary care, and increased awareness can all help promote improving the disparities in access to care.

Methodology

Avalere analyzed publicly available US population data from the Census Bureau. Avalere identified all psychiatric hospitals and CMHCs using cost report files from the Centers for Medicare and Medicaid Services and psychiatrists using data from the National Plan and Provider Enumeration System Registry.

Notes

  1. The Health Resources and Services Administration defines Health Professional Shortage Areas for mental health as having population to provider ratios of more than 30,000 to 1 and focuses solely on psychiatrists. In this analysis, Avalere simply calculated population to provider ratios at the state and the county level and expanded provider types to also include psychiatric hospitals and Medicare-certified CMHCs.

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