Survey Highlights Need to Improve Access to Mental Health and Substance Use Services

A new survey funded by the Mental Health Treatment and Research Institute LLC, a tax-exempt subsidiary of The Bowman Family Foundation, sheds more light on the deepening mental health and substance use crisis. Authors of a report which presents the survey’s findings call for urgent action to ensure equitable access to timely and clinically effective care and adequate reimbursement by insurers. The authors state that despite significant strides in recognizing mental health as a vital aspect of overall well-being, in-network health insurance coverage for mental health and substance use treatment remains inadequate, lagging behind coverage for physical health treatment. To shed light on this critical issue, NORC, a non-partisan research institute at the University of Chicago, conducted the patient-experience survey, providing valuable insights into the challenges faced by patients seeking mental health and substance use care.

Urgent Need for Mental Health Services

The survey highlights the pressing need for accessible mental health and substance use care. Patients across the nation are struggling to receive the treatment they require, facing barriers in finding in-network providers who accept new patients. The survey delves into the frequency with which mental health or substance use care is needed but not received, bringing attention to the potential consequences of unmet mental health needs.

As patients encounter difficulties with in-network providers, they often resort to seeking care from out-of-network sources. The survey explores the reasons behind this trend and analyzes the disparities between seeking mental health or substance use care versus physical health care. Understanding these patterns is crucial in devising strategies to enhance access to in-network care for all.

Patients often rely on primary care providers and other physical health providers for mental health or substance use care. However, the survey uncovers concerns regarding the adequacy of care provided by PCPs and physical health professionals for mental health conditions. Addressing these concerns could lead to more integrated and comprehensive care models.

The survey also examines the prevalence of service denials and disparities faced by patients seeking mental health and substance use care. These challenges not only hinder access to treatment but can also exacerbate existing mental health conditions, highlighting the urgent need for policy changes and awareness.

Key Findings

The survey reveals a significant disparity between mental health care and physical health care, emphasizing the urgent need for equitable and timely treatment options.

Limited Access to Mental Health and Substance Use Care: The survey found that 57% of patients seeking mental health or substance use care did not receive any care in at least one case, in contrast to 32% of patients seeking physical health care. The figures were even more alarming for adolescents, with 69% experiencing limited access to mental health and substance use care, compared to only 17% for physical health care. These statistics indicate a critical need to improve access to mental health services for patients of all ages.

Difficulties in Finding In-Network Providers: For those who use health insurance and seek care from in-network mental health or substance use providers, 40% had to contact four or more in-network providers before securing an appointment with a new in-network provider. In comparison, only 14% faced similar challenges when seeking physical health care. This highlights the challenges patients encounter when trying to find appropriate and available mental health care providers within their insurance network.

High Reliance on Out-of-Network Providers: A significant percentage of patients, particularly those in employer-sponsored health plans, sought care from out-of-network mental health or substance use providers. As high as 39% of patients used out-of-network providers for outpatient care, compared to just 15% for physical health care. The financial burden of higher co-pays and deductibles faced by patients using out-of-network providers underscores the urgency to improve in-network coverage for mental health and substance use care.

The Need for Specialized Care: An overwhelming majority of patients who received mental health or substance use care from physical health providers (87% of all ages and 98% of adolescents) felt that they needed additional help from a mental health or substance use specialist. This highlights the importance of integrated care and the crucial role of specialized professionals in addressing mental health and substance use issues effectively.

Collaboration is Key to Improving Behavioral Healthcare

The NORC patient-experience survey sheds much-needed light on the profound disparities in accessing mental health and substance use care in the United States. The findings underscore the pressing need for policymakers, insurers, and healthcare providers to collaborate and implement equitable solutions. By improving in-network insurance coverage, enhancing provider networks, and addressing service denials, we can take a significant step forward in ensuring that mental health and substance use care are on par with physical health treatment. Together, let us strive for a future where all individuals have access to timely and effective care, leading to improved mental well-being and healthier communities.

Senior Life Solutions Team Saves Patient’s Life

A recent incident at one of our Senior Life Solutions programs illustrates the vital role our teams play in ensuring the mental and physical health of older adults, and the strength of our partnerships with hospitals to produce positive patient outcomes. Doctors at a Tennessee hospital that hosts a Senior Life Solutions program credited our team with saving a patient’s life. (To ensure the privacy of the patient involved we’ve removed some details, including their name and the hospital location.)

About Senior Life Solutions

Senior Life Solutions (SLS) is a hospital-based outpatient program designed to meet the unique needs of adults typically ages 65 and older who are struggling with symptoms of depression and anxiety that can sometimes be age-related. Patients in SLS programs receive psychiatric care and meet at the hospital for group therapy sessions, which are typically held three times a week. When patients come to these sessions we check their vitals, including pulse, oxygen levels and temperature.

Discovering the Symptoms

On a recent Monday morning, an unexpected occurrence unfolded. The patient, who was never one to be tardy, was late for a group therapy session. The SLS team at the hospital called the patient, who said she’d been short of breath and was feeling weak after getting out of the shower. The patient arrived at the group therapy session and shared that she’d had difficulty going to church the morning before. She shared that, unlike her usual routine, she had been unable to attend the evening church service on Sunday. Even simple tasks, like reaching the restroom during a break, proved to be a struggle for her. Concern deepened as we realized the severity of her condition.

A registered nurse who is part of the SLS team checked the patient’s oxygen saturation levels. Shockingly, the readings hovered in the 70s range, well below the normal range in the 90s. However, there was a temporary improvement as her oxygen level rose to 90. Later another SLS team member rechecked the level, which had fallen back into the 70s range. Recognizing the urgency, they immediately alerted the respiratory team at the hospital.

Swift action was crucial to saving the patient’s life. She was promptly admitted to our partner hospital. Given the severity of her condition, she was later transferred to a larger hospital, where a multidisciplinary team of healthcare professionals provided specialized care. At the hospital, our patient’s resilience shone through as she faced numerous challenges head-on. With approximately 10 pounds of fluid removed, her condition began to stabilize. Although she remained hospitalized, her progress was evident, and hope illuminated her path to recovery.

A Life-Saving Intervention

Days later the patient’s doctor told our SLS team that had she not received timely treatment, she might have suffocated and tragically lost her life. Congestive heart failure, a condition affecting the heart’s ability to pump blood effectively, was identified as the underlying cause. It was a stark reminder of how important it is for older adults to have regular social interactions and routine checkups. Our patient’s story emphasizes the importance of listening to our bodies, seeking help when needed, and having a dedicated healthcare team by our side. Today, we celebrate the strides made in her recovery and wish her a future filled with health and vitality. May her story inspire others facing similar challenges to never lose hope and always believe in the incredible strength of the human spirit.

Medication Minute: Lamotrigine (Lamictal)

What Is Lamotrigine and What Does It Treat?

Lamotrigine is a mood stabilizing medication approved for treatment of bipolar disorder (also known as manic depression) and certain types of seizure disorders. It affects neural pathways in the brain. Bipolar disorder involves episodes of depression and/or mania. Lamotrigine may also be helpful when prescribed “off-label” for bipolar depression.

*Information for this report provided by the National Alliance on Mental Illness.

Download our PDF about Lamotrigine.

Generic name: lamotrigine (la MOE tri jeen)

  • Tablets: 25 mg, 100 mg, 150 mg, 200 mg
  • Chewable tablets: 5 mg, 25 mg
  • Oral disintegrating tablets: 25 mg, 50 mg, 100 mg, 200 mg
  • Extended-release tablets: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg


Brand names:

  • Lamictal®
    • Tablets: 25 mg, 100 mg, 150 mg, 200 mg
  • Lamictal Blue Starter Kit®
    • Tablets: 25 mg
  • Lamictal CD®
    • Chewable tablets: 2 mg, 5 mg, 25 mg
  • Lamictal ODT®
    • Oral disintegrating tablets: 25 mg, 50 mg, 100 mg, 200 mg
  • Lamictal® XR
    • Extended-release tablets: 25mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg
  • Subvenite®
    • Tablets: 25 mg, 100 mg, 150 mg, 200 mg
  • Subvenite Blue Starter Kit®
    • Tablets: 25 mg

Symptoms of depression include:

  • Depressed mood – feeling sad, empty, or tearful
  • Feeling worthless, guilty, hopeless, or helpless
  • Loss of interest or pleasure in normal activities
  • Sleep and eat more or less than usual (for most people it is less)
  • Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
  • Psychomotor agitation (‘nervous energy’)
  • Psychomotor retardation (feeling like you are moving in slow motion)

Symptoms of mania include:

  • Feeling irritable or “high”
  • Having increased self esteem
  • Feeling like you don’t need to sleep
  • Feeling the need to continue to talk
  • Feeling like your thoughts are too quick (racing thoughts)
  • Feeling distracted
  • Getting involved in activities that are risky or could have bad consequences (e.g., excessive spending)

Lamotrigine may also be helpful when prescribed “off-label” for bipolar depression.

What Is the Most Important Information I Should Know About Lamotrigine?

Bipolar disorder requires long-term treatment. Missing doses of lamotrigine may increase risk for a relapse in mood symptoms.

In order for lamotrigine to work properly, it should be taken every day as ordered.

Are There Specific Concerns About Lamotrigine and Pregnancy?

People living with bipolar disorder who wish to become pregnant face important decisions. It is important to discuss the risks and benefits of treatment.
Lamotrigine has been associated with an increased risk of oral cleft birth defects. There may be precautions to decrease the risk of this effect. Discontinuing similar medications during pregnancy has been associated with a significant increase in symptom relapse.
Regarding breastfeeding, caution is advised since lamotrigine does pass into breast milk.

What Should I Discuss with My Health Care Provider Before Taking Lamotrigine?

  • Symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
  • Any other psychiatric or medical problems you have
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breastfeeding
  • If you drink alcohol or use illegal drugs

How Should I Take Lamotrigine?

Lamotrigine is usually taken 1 or 2 times daily with or without food.
Typically, patients begin at a low dose of medication and the dose is increased slowly over several weeks.

The dose usually ranges from 25 mg to 400 mg.

What Happens If I Miss A Dose Of Lamotrigine?

If you miss a dose of lamotrigine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your dose or take more than what is prescribed. If you miss more than 3 days of medication, contact your prescriber because he/she may need to adjust your dose.

What Should I Avoid While Taking Lamotrigine?

Avoid drinking alcohol or using illegal drugs while you are taking lamotrigine. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

What Happens If I Overdose with Lamotrigine?

If an overdose occurs call your doctor or 911. You may need urgent medical care.
You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of lamotrigine does not exist.

What Are the Possible Side Effects Of Lamotrigine?

Common side effects of Lamotrigine include:

  • Nausea
  • Insomnia
  • Runny nose
  • Non-serious rash
  • Headache
  • Diarrhea
  • Abnormal dreams
  • Dizziness or drowsiness
  • Fatigue

Rare/serious side effects

A serious, life-threatening skin rash (also known as Stevens–Johnson Syndrome) may occur with the use of lamotrigine. Contact your health care provider immediately if you have any of the following: a skin rash, blistering or peeling of your skin, hives, shortness of breath, or painful sores in your mouth or around your eyes. Extra caution is needed in children and teenagers ages 2-17 receiving lamotrigine. These patients may be at an increased risk of developing this life-threatening rash.

Studies have found that individuals who take antiepileptic medications including lamotrigine have suicidal thoughts or behaviors up to twice as often than individuals who take placebo (inactive medication). These thoughts or behaviors occurred in approximately 1 in 500 patients taking the antiepileptic class of medications. If you experience any thoughts or impulses to hurt yourself, you should contact your doctor immediately.

Aseptic meningitis, a serious inflammation of the protective membrane that covers the brain and spinal cord has been identified as a very rare but serious side effect of lamotrigine. Contact your health care provider immediately if you experience headache, fever, nausea, vomiting, stiff neck, rash, unusual sensitivity to light, muscle pains, chills, confusion, or drowsiness while taking lamotrigine.

Patients with certain underlying cardiac disorders or heart rhythm problems may experience serious arrhythmias or life-threatening effects. Those with structural or functional heart disease should be counseled on risk versus benefits of using this medication.

A rare but life-threatening immune system reaction which can cause serious blood or liver problems has been reported with lamotrigine use. Contact your health care provider immediately if you experience fever, frequent infections, severe muscle pain, swelling of the face, eyes, lips, or tongue, swollen lymph glands, unusual bruising or bleeding, weakness, fatigue, or yellowing of the skin or white part of your eyes. Onset usually occurs within the first several weeks after starting therapy. Patients with HLH symptoms should be evaluated promptly; discontinuation and conversion to alternate therapy may be required.

Seizures may occur if a patient taking lamotrigine suddenly stops taking it.

Are There Any Risks for Taking Lamotrigine For Long Periods Of Time?

To date, there are no known problems associated with long term use of lamotrigine. It is a safe and effective medication when used as directed.
It is important to note that some of the side effects listed above (particularly rash and suicidal thoughts) may continue to occur or worsen if you continue taking the medication. It is important to follow up with a provider routinely and to contact a provider immediately if you notice any skin rash or changes in mood or behavior.

What Other Medications May Interact with Lamotrigine?

The following medications may increase the level and effects of lamotrigine:

  • Valproate/divalproex (Depakote®)

The following medications may decrease the level and effect of lamotrigine:

  • Anticonvulsants such as phenytoin (Dilantin®), carbamazepine (Tegretol®/Carbatrol®/Equetro®), phenobarbital, and primidone (Mysoline®)
  • Oral contraceptives (birth control pills)
  • Rifampin (Rifadin®), ritonavir (Norvir®)

Lamotrigine may increase the level and effects of:

  • Clozapine (Clozaril®, FazaClo®)

How Long Does It Take for Lamotrigine to Work?

It will typically take several weeks to see an improvement in symptoms.
Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder.

FDA Black Box Warnings

Serious Skin Reactions

Serious and sometimes fatal skin reactions have been reported with lamotrigine use. Since it is not always possible to predict which rashes will prove to be serious or life threatening, it is important to talk to your doctor at the first sign of a rash while taking lamotrigine.