More than 3 million New Yorkers have a diagnosed mental illness but only around one in three can get the care they need to treat it.

The barriers stem from many factors, like so-called "fail first" policies, which require people to try an insurer-preferred medication first, before covering the original prescription.

Matthew Shapiro, senior director of government and cultural affairs for the New York State Chapter of the National Alliance on Mental Illness, said another issue is what are known as "ghost networks."

"In some cases, up to 75% of providers that the insurance company gives to their client don't actually exist," Shapiro pointed out. "They're no longer practicing in the area. We call that 'ghost coverage,' where they're telling you coverage is there and it's not."

A 2023 New York State Attorney General report found 86% of providers listed on health plan networks are not valid listings. The report recommended state regulators crack down on insurers to maintain consistent and accessible levels of care for all. Another barrier is low mental health care reimbursement rates for providers.

As mental health issues rise nationally, insurance coverage needs to meet the moment. Federal laws like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act ensure behavioral health coverage is on par with other health care.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said loopholes in the laws still have to be closed.

"What mental health advocates across the country and in states are pushing for is to make sure when a doctor is recommending treatment, the health plan has to cover those services when they're consistent with what the standards of care are," Lloyd explained.

The biggest challenge to closing loopholes is lawmakers finding the political will to do so. Lloyd added the overall goal is to align providers' and insurers' standards of care, so patients get the treatment they need.

As Mississippi grapples with a growing mental health crisis, state and local leaders are being urged to prioritize diversion programs and crisis care systems to prevent the unnecessary incarceration of people with mental illness.

It is estimated 2 million people with serious mental illness are booked into jails across the U.S. each year.

Shannon Scully, director of justice policy and initiatives for the National Alliance on Mental Illness, said in Mississippi, where mental health resources are often scarce and the incarceration rate is among the highest in the nation, it means more than 19,000 people in state custody.

"The criminal justice system disproportionately impacts people with mental illness," Scully explained. "They are overrepresented in those spaces, and that's mostly because historically, our communities have underfunded and under-resourced behavioral health."

The Bureau of Justice Statistics reports 44% of people in jails and 43% in state and federal prisons have a mental illness. The Magnolia State has made some progress in recent years, leveraging federal funding to expand mental health services. However, advocates warned proposed budget cuts could jeopardize the gains.

Mississippi's prison system has long been under scrutiny for overcrowding and poor conditions, and a lack of mental health services exacerbates the problem. Scully pointed to "nuisance laws" criminalizing behaviors associated with untreated mental illness, such as public disturbances or sleeping in public, as key drivers of incarceration.

"Instead of implementing policies that may connect these folks to crisis services or to supportive housing, they are charged with a crime or they are ticketed," Scully emphasized. "They become involved with the criminal justice system."

As March marks Criminal Justice Awareness Month, she urged Mississippians to learn more about how mental health intersects with the justice system and to push for reforms. Scully promotes the importance of community engagement, pointing to resources like reimaginecrisis.org, where people can track legislation and advocacy efforts for mental health diversion and crisis care in their state.

Researchers at the University of Michigan have found that Black students attending Historically Black Colleges and Universities and Predominantly Black Institutions experience better mental-health outcomes compared with their peers at other institutions, but challenges remain.

The Healthy Minds Network, based at U of M, partnered with UCLA, Wayne State, and Boston University, to conduct the study in collaboration with the UNCF Institute for Capacity Building and the Steve Fund. Akilah Patterson, a doctoral candidate at the University of Michigan's School of Public Health, led the research and said the study involved 16 HBCUs and two PBIs, with more than 2,500 students participating.

"About 45% of them are flourishing mentally," she said. "Most notably, we saw that 83% of HBCU and PBI students reported having a sense of belonging in their campus community, compared to about 73% nationally."

However, the data also reveals significant challenges. More than half of the students report that their financial situation is "always" or "often" stressful, and 78% of those facing financial hardships are also dealing with mental-health issues.

In light of these challenges, the study recommends that colleges and universities address unmet mental-health needs, alleviate financial stress, expand on-campus mental-health resources and strengthen student-faculty connections.

Patterson said she hopes the report also underscores the importance of fostering a strong sense of belonging on campus and the crucial role HBCUs play in students' lives.

"HBCUs have a very long tradition of being centers of excellence and academic achievement," she said, "but this work also highlights that there are some mental-health challenges that do need to be addressed on those campuses so students can very much thrive academically."

As of 2023, HBCUs enrolled approximately 293,000 students. While originally established to serve Black students, as of 2015, non-Black students constitute about 22% of enrollment, up from 15% in 1976.


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Diagnoses of mental health conditions in children and teens are on the rise, including in Indiana. But getting kids the help they need can be a challenge.

About one-third of Indiana high school students reported "experiencing poor mental health, most of the time" in a 2023 survey.

But Jeff Reiter - a psychologist with Whole Team, a group that provides technical assistance to primary care clinics - said many parents have trouble accessing both medication and talk therapy for their kids.

He said he thinks what is most needed is more support for primary care providers - which is where mental health problems often are first identified.

"So they're getting those medications from a primary care provider," said Reiter, "a pediatrician, a family medicine, family doctor or something like that. And these are providers who don't have a lot of time in their visits, maybe 15 minutes. They're not specialists - they don't get a ton of training in how to work with psychiatric issues in kids."

Reiter advocated for placing mental health professionals in primary care clinics, to make them more easily accessible to patients and their parents.

He said he also supports what's known as parent management training as a non-medication option for youth with mental health concerns.

Advancements in mental health treatment programs and medications have been helpful. However, these services can be out of reach for a patient with limited or no insurance coverage.

Reiter said he agrees the traditional psychotherapy treatment model can be costly - a factor he said he sees as part of the access problem. But he maintained there's a more relevant issue.

"The point is, there are much more flexible and accessible ways that mental health professionals can practice," said Reiter, "and that's really what we need to be encouraging if we're going to have any chance of reaching more kids."

A study published in 2023 found in Indiana, in one recent year, untreated mental illness was associated with more than $4 billion a year in costs to society.





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