MORE THAN ONE-QUARTER of Massachusetts adults say they needed behavioral health care over the first year of the pandemic – but many of them never got it. They couldn’t get an appointment, or they couldn’t afford it, or they felt the stigma of needing mental health care, according to survey data. 

A new report by the Blue Cross Blue Shield Foundation of Massachusetts highlights what has been called the pandemic within a pandemic: the immense mental health struggles caused by virus-related stress and isolation. The Blue Cross survey is the first to examine how the mental health of a broad cohort of Massachusetts adults were affected by the pandemic. The report finds large numbers of adults having problems with alcohol and cannabis use. It finds many adults suffering from mental health issues. But it also finds that many of those adults – particularly younger adults, people of color, and low-income individuals – had trouble accessing the behavioral health care they need. 

“Massachusetts adults are reporting that we definitely have a crisis associated with the pandemic, and that’s unmet behavioral health needs,” said Audrey Shelto, president and CEO of the Blue Cross Blue Shield Foundation of Massachusetts. 

The foundation, which is affiliated with but independent from the insurance company, has for years chronicled the gaps in Massachusetts’ system of behavioral health care. Its latest report was based on a survey of more than 1,700 Massachusetts adults commissioned by the foundation and done by NORC at the University of Chicago, a nonpartisan research institute, between December 2020 and March 2021. It asked respondents to look back at the prior year. 

The survey found that 35 percent of adults reported needing behavioral health care for themselves or a close relative in the past year. Twenty-seven percent needed care for themselves. The need was highest among 19 to 39-year-olds, with half of adults in that age group saying they needed care. Low-income adults and non-Hispanic Whites also reported needing care at higher rates than wealthier adults and Whites. 

An identical survey was not done pre-pandemic, so there is no way to compare the level of need before and after. But almost two-thirds of respondents said their need for behavioral health care was due to or exacerbated by the pandemic. 

Shelto said she does not have an explanation for why 19 to 39-year-olds were disproportionately in need of care. She said previous studies have shown that people who are low income tend to have trouble finding a provider that accepts MassHealth. People who are not White or not English speaking tend to have a hard time finding a provider who looks like them, can communicate with them, or understands their culture. “There’s that barrier in terms of race, ethnicity, and I’m sure linguistically,” Shelto said. 

Of those who reported needing care, many did not get it. Among survey respondents, 26 percent said they did not get care at all, and another 31 percent got some care, but not when they felt they needed it. Some of this is due to people deciding not to seek care – of those who reported needing care, 16 percent, or 73 respondents, did not try to get it. They cited a range of concerns, including stigma, affordability, and accessibility. Of 45 respondents who tried to get care but were unable, the majority cited cost and accessibility. Some of those – 11 percent – were individuals who did not have insurance all year. 

Shelto said previous studies have demonstrated a gap between the need for outpatient mental health care and supply. “People wait months sometimes to get an outpatient appointment for themselves or for their children,” Shelto said. She added that the need for care has grown during the pandemic, at the same time as clinicians are leaving the field or taking time off for COVID-related reasons.  

With regards to affordability, there are many providers who do not take MassHealth, and some who do not take any insurance.  

The survey also asked about substance use during the pandemic and found that 28 percent of respondents reported consuming alcohol or cannabis more since the pandemic started. For 17 percent, the use caused serious problems in their life, like missing work or school, losing a job, or neglecting children. Alcohol and cannabis were equally likely to cause serious problems. Demographically, the adults with serious problems from substance use tended be younger and less educated, but they spanned income levels, race, and gender. 

Massachusetts health officials have acknowledged the need to reform the behavioral health system. Secretary of Health and Human Services Marylou Sudders announced a “roadmap” for behavioral health reform last year. Gov. Charlie Baker’s fiscal 2023 budget proposal includes a $115 million investment in new behavioral health services, including a 24-hour helpline, a behavioral health urgent care program, and an expansion of community treatment programs.  

Shelto said while there is an unprecedented mental health crisis, “we also have an unprecedented commitment among the state administration, the Legislature, even federal funding to address this crisis.”  

Between Baker’s behavioral health roadmap, a Senate bill addressing insurance coverage for behavioral health care, and new pots of federal money, Shelto said progress is being made. “It is a coming together and shared perception of the urgency of the crisis and the need to address it that I haven’t seen before,” she said.