Mental Health Conditions and Access to Care Among Adults in Southeastern Pennsylvania

On January 1, 2010, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 will go into effect. Signed into law by Congress in October 2008, the Act will address some disparities in insurance coverage of mental health treatment compared to coverage of medical treatment. Although some 113 million Americans will soon have improved access to mental health care if they need it, many individuals with diagnosed mental health conditions will still suffer with limited or no access to care, including medical care.

Analysis of the Community Health Data Base’s Southeastern Pennsylvania Household Health Survey data shows some challenges in accessing health care for the region’s adults who have a diagnosed mental health condition.

Diagnosed Mental Health Conditions

About 523,300 adults, or 17.8% of those 18 and older, in Southeastern Pennsylvania have been diagnosed with any mental health condition, including clinical depression. More than four in ten adults (43.3%) who have been diagnosed with a mental health condition are not receiving treatment, representing 226,300 adults in the region.

The population of adults in Southeastern Pennsylvania diagnosed with a mental health condition is more likely to be poor and female than adults who do not have a diagnosed condition.  Nearly one in five (18.9%) adults with a mental health condition lives below the Federal Poverty Line compared to about one in ten (8.9%) adults who have no mental illness. Among adults who have been diagnosed with a mental health condition, 67.3% are women and 32.7% are men. Furthermore, slightly less than half (46.1%) of adults who have been diagnosed are 50 years old or older.

Access to Health Care

In Southeastern Pennsylvania, adults diagnosed with clinical depression or other mental health conditions are more likely than other adults to experience certain cost and transportation barriers in access to care.  More than one in five (21.5%) adults with mental illness were sick but did not seek care due to cost, representing 112,200 adults in the region, compared to 9.5% of adults with no diagnosed mental health condition. Almost one-third (28.2%) of adults with any diagnosed mental health condition did not get a prescription filled due to the cost, compared to 12.8% of other adults. About 93,000 adults or 17.8% with a mental health condition canceled a doctor’s appointment in the past year due to transportation problems. This proportion is lower among adults with no diagnosed mental health conditions (5.2%).

However, adults with a mental health condition are more likely to have a regular source of health care and have seen a health care provider in the last year than other adults. Less than one in ten (7.1%) adults who have a diagnosed condition have no source of regular care compared to more than one in ten (11.1%) adults without a mental health diagnosis. In Southeastern Pennsylvania, adults with mental health conditions are more likely to utilize places other than a doctor’s office for their regular care. For example, 8% of adults with a mental health condition visit a community health center or clinic for their regular care compared to 5.4% of other adults.

Furthermore, adults with diagnosed mental illnesses are more likely to have seen a health care provider in the past year than those without a diagnosed condition. Among those with any mental health condition, including depression, 91.1% saw a doctor in the past year. Among the region’s adults without a mental health diagnosis, 83.4% saw a provider in the last year.

When it comes to health insurance status, there are no disparities. The proportion of adults aged 18-64 with and without diagnosed mental illnesses who do not have health insurance is nearly the same (9.7% and 9.8%, respectively). However, those figures indicate that nearly one in ten of each group does not have health insurance and may suffer reduced access to care, representing a staggering total of 237,000 Southeastern Pennsylvanians without medical coverage.

Data from the Southeastern Pennsylvania Household Health Survey provide an interesting look at access to health care among the region’s adults with diagnosed mental health conditions. Adults with diagnosed mental health conditions experience greater cost and transportation barriers to accessing care than other adults. Local policies and programs should reflect the health access needs of individuals with diagnosed mental illnesses, and ensure equitable and sufficient access to care.

For information regarding PHMC’s Community Health Data Base Southeastern Pennsylvania Household Health Survey, or to learn more about access to care issues among local residents with mental health conditions, contact Amanda Innes Dominguez at (267) 350-7695 or ainnes@phmc.org.