The impact of unmet mental health needs

New research on insured Americans finds that those reporting mental health conditions were significantly more likely than others to struggle to get effective healthcare, a stark reminder that access to insurance doesn’t guarantee positive health outcomes. A proactive, stigma-reducing strategy, experts say, that considers mental healthcare through a prevention lens can make the difference for both workers and organizations.

Conducted by the Employee Benefit Research Institute and released by the Path Forward Coalition, the survey captured the experiences of 3,100 workers with employer-based insurance. Among the key findings, more than one in four workers (27%) reported they or someone on their health plan has a mental health condition. These individuals were more likely than those without such conditions to be younger, married with children and employed at smaller firms.

Respondents reporting a mental health condition were twice as likely as those reporting no mental health condition to be unable to get medical care, tests or treatment that they or a doctor believed necessary over the past six months. About a third of those struggling to access treatment said they were seeking mental or behavioral healthcare, and another third faced obstacles getting the prescriptions they needed.

Employees are ‘trying’

Those with a mental health condition were nearly twice as likely as those without to cite a doctor’s refusing their insurance as a main barrier to care. Other top challenges include being able to take time off work to seek treatment and getting childcare.

According to Anna Bobb, executive director of the Path Forward Coalition, the data shows that individuals reporting mental health conditions are being proactive about getting their needs met—including through price comparisons, clinician quality research and talking about treatment and prescription options with providers.

“That suggests problems getting mental healthcare aren’t due to lack of trying,” she says. “The ER shouldn’t be frontline treatment for mental illness any more than it should be frontline treatment for heart disease.”

Nearly two-thirds of workers with a mental health issue have visited an emergency room in the last six months—a figure that is 50% higher than for workers without a mental health condition.

Apart from the employer costs related to high ER utilization, heavy ER use is a clear signal to employers that preventive and routine care aren’t working the way they should, says Paul Fronstin, director of health benefits research at EBRI. This can drive up expenses for plans, disrupts employees’ lives and, ultimately, contribute to absenteeism, presenteeism and turnover.

“Our survey found that these unmet needs are far more common in mental health than in physical health, and employees are more likely to delay or skip treatment altogether, even when they recognize the need,” he says.

A preventive approach to mental healthcare

The higher incidence of unmet mental health needs among populations like working parents or younger employees, groups that are central to talent pipelines and retention, make it all the more important for employers to address these challenges.

“That suggests employers need to think differently about parity—benefits may look strong on paper, but in practice hurdles remain,” he says.

Among the strategies he recommends are normalizing the use of mental health benefits, integrating them into wellness strategies and holding vendors accountable for access and quality. While cost and provider availability remain significant barriers, he says, employers can respond by reviewing plan design, expanding virtual networks and contracting with vendors to fill access gaps, while recognizing that broader workforce shortages require policy solutions.

“Mental health not just an individual issue but a family and workforce issue, one employers can’t afford to ignore,” Fronstin says.

“For too long, stigma has pushed mental healthcare into the shadows,” adds Bobb. Led by HR, leaders and managers can encourage employees to seek help at the first signs of trouble and measure uptake to ensure workers are being served.

Early intervention—especially brief, evidence-based treatments—works, she says. By treating mental healthcare as prevention, employers can save lives, boost productivity and lower costs.

“Employers pour billions into benefits,” she says. “It’s in everyone’s interest to ensure they work. Closing mental health gaps is about more than benefit design. It is a business imperative that drives retention, productivity and as a result, America’s economic strength.”