How Medical Debt Is Widening the Mental Health Care Gap in America

Nearly one in every 12 Americans owes medical debt, totaling at least $220 billion nationwide. 

This debt may be actively worsening the mental health care gap.

Adults with depression or anxiety are more likely to carry medical debt, according to a study published in JAMA Psychiatry. Approximately one in four to one in five of these people reported that they could not pay their medical bills. 

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Researchers found a potential link between increased debt among people with anxiety or depression and delaying or forgoing mental health care.

“Medical debt appears to contribute to the mental health treatment gap, suggesting that aggressive debt collection practices have negative consequences for population mental health,” the study’s authors wrote. “In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.”

Medical debt has soared in recent decades, which the authors connotate with increasingly aggressive debt collection tactics, including wage garnishment, property liens and lawsuits.

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Medical debt impacts the timeliness of care in all medical specialties but is especially consequential in psychiatry because of the already persistent treatment gap.

The study analyzed data collected in 2022 from the National Health Interview Survey (NHIS). The dataset included more than 27,500 adults. Of these adults, 18.2% reported having depression in their lifetime and 17.7% reported having anxiety in their lifetime.

Among those who reported having depression, 19.9% reported medical debt, compared with 8.6% among those without depression. For adults with a history of anxiety, 19.4% reported medical debt, while only 8.8% of those without anxiety reported having medical debt.

The study’s findings are “meaningfully higher” than national estimates of medical debt, aligning with the authors’ findings that having depression or anxiety is associated with a higher likelihood of debt.

Debt was common even among those with health insurance, as more than 90% of the study’s participants were insured, but 19.4% to 27.3% reported medical debt.

Medical debt was significantly associated with a higher likelihood of delayed mental health care or forgone mental health care in all participants.

“The burden of medical debt has not been equally distributed, and the heightened burden among adults with psychiatric disorders is likely explained by lesser financial resources among people with common mental disorders,” the study’s authors wrote. “This issue is likely compounded by low rates of psychiatrists’ participation in insurance networks, causing patients to face high out-of-pocket costs for psychiatric care.”

Researchers did not find that the participants’ incomes impacted the association between debt and the timeliness of mental health care.

In light of a lack of structural health care reform, many states have created laws to protect patients from medical debt. However, these policies vary widely from state to state. 

The authors recommend further research to evaluate policies that could protect against medical debt at the federal level.

“Such protections may aid in addressing barriers to treatment for individuals with mental and behavioral disorders,” the authors wrote.