Scope of the Issue

Our national office develops an annual report on the state of Mental Health in America that is a helpful resource for mental health advocates nationwide who fight tirelessly to help create parity and reduce disparity for people with mental health concerns.

In this report, there are 15 measures that make up the overall ranking among all 50 states.  Missouri ranks 30th for adult and youth measures, which means that our state has a higher prevalence of mental illness and lower rates of access to care.  The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education and workforce availability. 

Key Findings – State of Adult Mental Health Nationally

1 in 5 Adults have a mental health condition. That’s over 44 million Americans; more than the populations of New York and Florida combined.
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4.19%, or over 10.3 Million Adults, have serious thoughts of suicide in the U.S.
Over 24 MILLION people nationwide experiencing a mental health illness are left untreated!

Key Findings – State of Adult Mental Health in Missouri

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18% of adult Missourians are living with a mental illness – that’s 828,000 people!
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Our state has the 2nd highest ranking for adults with serious thoughts of suicide.
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In Missouri, 52%  of people with mental illness  are untreated.

Reasons Why People Are Not Receiving Treatment

  • Lack of insurance or limited coverage of services
  • Shortfall of psychiatrists, and an overall undersized mental health workforce
  • Lack of available treatment types (inpatient treatment, individual therapy, intensive community services)
  • Disconnect between primary care systems and behavioral health systems
  • Insufficient finances to cover costs – including copays, uncovered treatment types, or providers who do not accept insurance
  • Despite the enactment of the Mental Health Parity and Addiction Equity law (MHPAE), private insurances have found subtle ways to limit coverage of mental health services. Insurance arbitrarily defines what services are “medically necessary” and should receive coverage.  A survey conducted by the National Alliance of Mental Illness showed that 29% of respondents reported that they or a family member were denied treatment because they were not deemed medically necessary.  Additionally, the MHPAE did NOT remove limitations on patient visits and number of co-payments imposed by insurers. 
  • Finally, contributing to lack of coverage is the severed relationship between mental health providers and insurers. Many health providers refuse to accept insurances primarily because insurers continue to underpay them for their services.  As a result, insured individuals are left with two options: costly, out-of-network services or no treatment. 
  • Interestingly, more Americans have access to service. Access to insurance and treatment has increased, as healthcare reform has reduced the rates of uninsured adults. Research indicates that 19% of adults remain uninsured in states that did not expand Medicaid and 13% of adults remain uninsured in states that did expand Medicaid.
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In Missouri, Medicaid Expansion is not yet a reality, but efforts are underway to include that question on the 2020 ballot. 

Expansion would mean coverage for an additional 200,000 Missourians!

Key Findings – State of Youth Mental Health

Nationwide, there are 2 MILLION youth (age 12 – 17) who are coping with severe major depression.  This number continues to increase each year! According to SAMHSA, these youth reported the maximum level of interference over four role domains including; chores at home, school or work, family relationships and social life. 

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64.6% of Missouri youth with major depression do not receive any mental health treatment. One of the reasons is the late recognition in primary care settings.
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In 2018, there were 21,000 Missouri youth who reported a substance use disorder!
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In Missouri, there are 14,000 children with private insurance who did not receive coverage for mental or emotional problems!

8% of Missouri students, meet the criteria for Emotional Disturbance for an Individual Education Program (IEP). For purposes of an IEP, the term “Emotional Disturbance” is used to define youth with a mental illness that is affecting their ability to succeed in school.
  • Early identification for IEPs is critical! IEPs provide the services and support students with an emotional disturbance need to receive a quality education.  Inadequate education leads to poor outcomes such as low academic achievement, social isolation, unemployment and involvement in the juvenile system. 

Mental Health Workforce

The term “mental health provider” includes psychiatrist, psychologist, licensed clinical social workers, counselors, marriage and family therapists and advanced practice nurses specializing in mental health care. 

A shortage of mental health providers has resulted in many individuals not accessing care and/or relying on emergency services for psychiatric care.  The National Council for Behavioral Health reported during a recent three-year period there was a 42% increase in the use of emergency services. 

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In Missouri, the ratio of people to providers is 590:1. There are only 14 other states that have a WORSE ratio.
We must work to integrate primary care and behavioral health services for early identification and intervention, but this is only part of the solution.  Primary care providers cannot fill the void of psychiatrists.  In 2025, it is estimated that 50% of psychiatrists will retire and the number of physicians willing to enter psychiatry continues to decline.  This is primarily due to inadequate reimbursement by payers, pushing psychiatrists into private practices that do not accept insurance.

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