Gaps in mental health care services are pervasive in the United States, at a time when deaths from suicide, alcohol, and drugs have surged, according to a new report released today by the Commonwealth Fund.
The combined rate of deaths from suicide, alcohol, opioids, and other drugs — sometimes called “deaths of despair” — increased 50% from 2005 to 2016. Rates rose in all states, doubling or more than doubling in Delaware, New Hampshire, New York, Ohio, and West Virginia, the report notes.
What’s more, the pace seems to have picked up. Average annual growth in deaths of despair was 3% per year from 2005 to 2014 but tripled to 9% from 2015 to 2016.
“This is one of the most troubling mortality trends we see in this year’s report,” David Radley, PhD, senior scientist at the Commonwealth Fund, noted in a media briefing outlining key findings from the Commonwealth Fund’s 2018 Scorecard on State Health System Performance.
The report assesses all 50 states and the District of Columbia on 43 measures dealing with access to healthcare, quality of care, efficiency in care delivery, health outcomes, and income-based healthcare disparities.
“The Scorecard reports, published since 2006, are a comprehensive overview of how well the healthcare system is working for the American people,” said David Blumenthal, MD, president of the Commonwealth Fund.
Although the 2018 Scorecard report provides some “good news about the direction we are heading, we do continue to see wide disparities between states,” said Blumenthal.
“Also of concern are some areas where we see no progress or even reversal of positive trends. For example, life expectancy has fallen, in large part due to the opioid epidemic; premature deaths from preventable or treatable causes are increasing in many states; and obesity rates continue to rise representing a public health crisis of grave concern,” Blumenthal said.
Unmet Mental Health Care Needs
The report confirms that accessing mental health care is tough in the United States. Up to one quarter of adults with a mental illness reported a need for care that was not met during the 2013-2015 period, and up to one third of children needing mental health treatment in 2016 did not receive it. Across states, 41% to 66% of adults with symptoms of a mental illness received no treatment in 2013-2015.
Deaths from treatable conditions are also moving in the wrong direction. After trending downward for most of the past decade, there has been an uptick nationally in premature deaths from preventable or treatable causes — a measure called “mortality amenable to health care.”
Two thirds of states saw an increase in 2014-2015 in this measure. In six states — Colorado, Maine, Nebraska, Oklahoma, Vermont, and Wyoming — the increase was greater than 5%.
“Premature deaths are on the rise in states across the country. Some of this is driven by deaths from substance abuse, but increases in deaths from treatable conditions is a sign that healthcare systems are also falling short,” said Radley.
Obesity remains an ongoing public health threat as well, the report notes. In Mississippi and West Virginia, the proportion of adults who are obese reached 39% in 2016. Even in states with the lowest rates, a quarter of all adults are obese.
Best, Worst Performers
Still, on balance, the 2018 report shows that across all dimensions of performance of state healthcare systems, there was more improvement than worsening from 2013 to 2016 — a reversal of what happened during the 2000s, when progress stalled or perfomance worsened.
By region, New England, the Upper Midwest, and several states in the West are at the top of the overall rankings. Southern states generally rank at the bottom.
By individual state performance, Hawaii, Massachusetts, Minnesota, Vermont, and Utah are the top-ranked, and Louisiana, Oklahoma, and Mississippi are the bottom-ranked.
California and Oregon made the greatest gains, jumping 9 and 10 spots, respectively. Both states expanded eligibility for Medicaid.
New York improved on 18 of the 37 indicators tracked over time, the most of any state. Arkansas, Louisiana, Oklahoma, and West Virginia each improved on 17 indicators.
The report also shows that the expansion of Medicaid has led to gains in access to care. In 47 states, the rate for adults aged 19 to 64 who are uninsured was at least five percentage points lower in 2016 than it had been in 2013. Eleven of the 13 states in which there was at least a 10-point drop had expanded Medicaid overage by January 2016. During this time, there was also a drop in the percentage of people reporting that they had not gone to the doctor when needed, owing to cost. States that expanded Medicaid coverage saw greater improvement, on average, than states that did not.
“Scaling back or even repealing pieces of the Affordable Care Act could put many of those improvements that we see in the Scorecard in jeopardy across states,” Radley warned.
The report concludes that if every state achieved the performance of the top-ranked state on each indicator, the gains in healthcare access, quality, efficiency, and outcomes would be “dramatic.” With the current rates of improvement, however, it may take many years or decades for states and the nation to see such progress.
Table. National Gains If All States Achieved Top Rates of Performance
| 18 million more adults and children insured |
| 14 million fewer adults skipping care because of cost |
| 26 million more adults with a usual source of care |
| 11 million more adults undergoing recommended cancer screenings |
| 837,000 more young children receiving all recommended vaccines |
| 1 million fewer Medicare beneficiaries receiving a high-risk prescription drug |
| 440,000 fewer hospital readmissions |
| 5.7 million fewer unnecessary emergency department visits |
| 89,000 fewer deaths before age 75 from treatable disease |
The full report is available online.
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