More Americans died by suicide in 2022 than any other year on record in the United States.

Still, significant barriers to care, including lack of insurance and clinician shortages, have kept many Americans from accessing much-needed behavioral health care, according to a new report from Mental Health America (MHA) based on federal data from 2022.

“We are living in a time of polycrisis when evidence shows that the need for mental health care is urgent,” Schroeder Stribling, president and CEO of MHA, said in a statement. “High numbers of adults and youth alike are having serious thoughts of suicide, following a year with a record high number for completed suicides, substance use is on the rise, and other indicators of distress and disparity continue to escalate. And yet obstacles such as high costs or a shortage of mental health providers prevent so many Americans from accessing the help they need.”

Lack of insurance or financial resources can keep patients from receiving needed care.

Just over 10% of American adults with a mental illness do not have health insurance, the report found, representing nearly six million people. Almost a quarter of adults who experience 14 or more mentally unhealthy days a month could not afford to see a clinician, a 2% increase from the previous year.

Misconceptions about behavioral health conditions may also be keeping people from care. Just over 75% of American adults with substance use disorders (SUDs) who considered receiving treatment did not receive care because they believed they should be able to handle their condition on their own.

The persisting shortage of behavioral health providers further hinders access to care.

Mental health providers continue to be in short supply and high demand. There are 340 Americans for every mental health provider in the U.S., and over 122 million people live in an area described as a mental health workforce shortage area.

In these areas, 73% of the total need for mental health care goes unmet.

Using peers

To mitigate the unmet need for mental health care, the report’s authors recommend increases in the usage of peer support specialists. Peers are a cost-effective way to drive patient engagement and are becoming increasingly common among behavioral health providers.

Multiple businesses offering peer support services have received investor attention in the last year. In June, virtual peer-based SUD provider Marigold Health raised $11 million. Digital peer support startup Forum netted $5.3 million in seed funds in November 2023.

But many peer support specialists do not make a living wage, the report’s authors wrote. To keep peers in the workforce, they recommend states raise reimbursement rates for these services.

The report ranked U.S. states based on 15 measures, including prevalence of mental illness and accessibility of care. Massachusetts ranked highest, followed by Connecticut and Maine. The three states with the lowest scores were Montana, Arizona and Nevada.

Nevada fell into the lowest spot based on high rates of youth behavioral health conditions, including high rates of SUDs, major depressive episodes and insufficient insurance coverage.

A focus on youth

Youth behavioral health issues are common across the country. Thirteen percent of youths ages 12 to 17 reported serious thoughts of suicide, and one in five youths had at least one major depressive episode in the last year.

Of those who experienced a major depressive episode, over half did not receive treatment. For those who did receive care, only 65% said it helped them.

Behavioral health companies are increasingly entering the youth treatment market, improving access to care for young people.

In April, virtual pediatric mental health startup Bend Health expanded its services to include care for young people up to age 25. 

Talkspace has forged partnerships to provide teens with free services. The provider launched its NYC Teenspace program in November, offering teens free check-ins with therapists. In December, Talkspace partnered with Baltimore County Public Schools (BCPS) to provide more than 32,000 students free therapy.

Patient-matching platform Headway’s founder launched his own youth-focused behavioral health startup, Marble, in June. The virtual therapy company promises appointments within four days and accepts “all insurances.”