We all need healthcare, but for low-income individuals healthcare is almost completely inaccessible. Almost 70% of the uninsured population is poor and 18% of the non-elderly population doesn’t have health insurance. And it’s even worse for people experiencing a mental illness, which is one-in-four individuals each year according to NAMI. Why is it so hard for the people in need to gain access to healthcare? There are three main barriers: cost, stigma, and access.
The Cost Barrier
Health insurance in the United States is based on the idea that it will be provided by an employer and the cost to obtain insurance reflect this structure. This means health insurance is nearly impossible to afford for those who have to pay for it individually. And the cost to see a healthcare professional without insurance is just as unaffordable. The Institute for Research on Poverty found that “The uninsured tend to forego preventative care and to wait until an illness is severe before seeking medical care.”
Not having proper access to healthcare doesn’t just affect an individual when they are sick. It can also lead them to participate in unhealthy behaviors as an alternative to seeking professional help. Health Affairs also found that “in a nearly stepwise fashion, low-income Americans have higher rates of physical limitation and of heart disease, diabetes, stroke, and other chronic conditions, compared to higher-income Americans. Americans living in families that earn less than $35,000 a year are four times as likely to report being nervous and five times as likely to report being sad all or most of the time, compared to those living in families earning more than $100,000 a year. These disparities emerge early in life and can be transmitted across generations. For the 6.8 million children living in deep poverty (those with family incomes of less than half of poverty), there are adverse consequences across the life course related to nutrition, environmental exposures, chronic illness, and language development. Low-income Americans also have higher rates of behavioral risk factors—smoking, obesity, substance use, and low levels of physical activity—which are powerfully influenced by the more challenging home and community environments in which they live. […] Low-income people may also have limited access to cessation counseling services and pharmacotherapies and may experience higher levels of chronic stress—all of which make it more difficult to stop smoking. Perhaps unsurprisingly, people in families that earn less than $35,000 a year are three times more likely to smoke as those in families with an annual income of more than $100,000.”
Mental health services are becoming more important as the stigma around seeking help decreases. However, available services are insufficient despite 56% of Americans seeking help.
The National Council found that “Forty-two percent of the population saw cost and poor insurance coverage as the top barriers for accessing mental health care. One in four (25%) Americans reported having to choose between getting mental health treatment and paying for daily necessities.”
This disparity between cost and need is especially poignant for those living just above the poverty threshold. Health Affairs explains “not all low-income people with serious mental illnesses are eligible for Medicaid, because they aren’t disabled enough to qualify for Supplemental Security Income (SSI); they don’t meet other Medicaid eligibility criteria (such as single adults or immigrants); or they are homeless, incarcerated, or too ill to follow through with the enrollment and eligibility process. With states shifting an increasing proportion of their mental health budgets onto Medicaid, fewer state funds are available to provide services for low-income uninsured people with serious mental illnesses who are not eligible for Medicaid.”
The Stigma Barrier
In recent decades, there have been many movements to reduce the stigma surrounding mental health and seeking treatment for it. Although significant progress has been made, stigma is still a social barrier for many suffering from a mental illness.
The National Council found “Nearly one-third of Americans, or 31%, have worried about others judging them when they told them they have sought mental health services, and over a fifth of the population, or 21%, have even lied to avoid telling people they were seeking mental health services. This stigma is particularly true for younger Americans, who are more likely to have worried about others judging them when they say they have sought mental health services (i.e. 49% Gen Z vs. 40% Millennials vs. 30% Gen X vs. 20% Boomers).” They also found that “Rural Americans are also less accepting of mental health services and care.”
Because of this stigma, many people do not even know where to go for the services they need. This lack of awareness and understanding, added to the stigma, can make finding the proper care nearly impossible on its own.
Social stigma around mental health services makes seeking help even harder for those who already struggle to afford care and medication. However, for some these services aren’t even present where they live.
The Access Barrier
This map from Mental Health America shows the states ranked by their access to mental health services.
For many people, especially those living in rural communities, finding a healthcare professional may mean driving long distances away and long waits. The National Council found “Ninety-six million Americans, or 38%, have had to wait longer than one week for mental health treatments. And nearly half of Americans, or 46%, have had to or know someone who has had to drive more than an hour roundtrip to seek treatment.” They also found that the lack of awareness leaves many low-income individuals to seek treatment at their local community centers instead of qualified mental health centers. And those low-income individuals living in rural communities are more likely to rely on their primary care doctor or community center for treatment for mental health services.
Not everyone has equal access to health care and especially mental health services. This is one societal structure that actively harms low-income individuals. It’ll require a lot of work and change to make access to care affordable for everyone, but together we can make it happen.