Mental Health Project

Mental Health Project

Mental Health Project

The Report: Click here to read our report, “The Urgency of Early Engagement: Five Persistent Barriers to Mental Health Treatment, Care and Recovery in Massachusetts and the Search for Solutions.”


Health Care For All (HCFA) began its work when The Peter and Elizabeth C. Tower Foundation funded a broad overview of the behavioral health barriers that people face when trying to get care, particularly for individuals attempting to cope with mental illness as well as their families, providers and other allies. The research initially focused exclusively on insurance barriers, mostly relating to mental health parity. However, the information coming back took us in another direction: early barriers to getting care can have a significant impact on a person’s potential for recovery.

Information Gathering:

HCFA conducted a year-long study of on-going barriers to early mental health treatment, care and recovery. The study included:

  • Over twenty-five initial stakeholder interviews with  providers, advocates, public officials and nonprofit leaders
  • Four focus groups of individuals with lived experience and two focus groups of providers
  • A statewide online survey of individuals and family members who had sought mental health treatment in the previous three years
  • Analysis of 2,000 call logs received by NAMI Compass, the resource helpline of NAMI Massachusetts
  • Analysis of 300 call and email logs recorded by the Massachusetts Attorney General’s Office (AGO) related to mental health care
  • A nine-person expert discussion group that included peers, family members, clinicians, advocates and former public officials

Five Persistent Barriers to Mental Health Treatment, Care and Recovery:

1.Knowledge Barriers:  A significant lack of knowledge about mental illness and the resources available for treatment and support pervade every step of the overwhelming journey to recovery.  For many individuals, a lack of knowledge prevents them from even being able to recognize that they need help. Thereafter, if a need for help has been acknowledged, lack of knowledge means not having any idea about where to turn for help, how to deal with the complexities of locating available services and how to navigate the insurance system and understand insurance benefits.

2.Attitude Barriers: Due to external prejudices and internal shame, individuals will often delay, avoid and even dislike the help they need. The name usually given to this debilitating prejudice and shame is stigma, but using that label often ends rather than starts a conversation. When fully unpacked, the phenomenon of stigma reveals deep and varied barriers to engagement.

3.Insurance Barriers: The difficulties people face in navigating the complexities of insurance coverage—including mental health coverage—are particularly unfortunate despite Massachusetts’ gains as a state with near universal coverage.  Consumers inevitably reach out to insurance companies upfront as an important point of contact. They could, therefore, serve as allies and guides to their members. Instead, most respondents viewed their insurers as adversaries. This adversarial relationship is compounded by the failure to fully implement mental health parity.

4.Price Barriers:  The aggregate price of recurring co-pays, high deductibles and the small-and-growing-smaller pool of mental health providers who accept insurance make mental health care prohibitively expensive for many people.

5.Delivery Barriers:  Even when insurance coverage applies, finding effective treatment rather than treatment in name only is much more difficult than it should be. Moreover, current commercial insurance coverage leaves out treatments critical to early treatments.

Summary of Recommendations:

  • To overcome barriers, Massachusetts should help promising programs grow to scale. Two immediate candidates are the INTERFACE referral service (INTERFACE) and Bridge for Resilient Youth in Transition (BRYT). Other programs deserving consideration are described in Section III, and still others are waiting to be discovered.
  • Massachusetts should commit to closing the knowledge gap by creating a state-of-the-art resource helpline and promoting its use statewide.  A promising project with that goal is now underway.
  • Massachusetts should expand the training and employment of people in peer support roles.  One major step in that direction would be MassHealth payment for Certified Peer Specialists.
  • Massachusetts should require increased transparency of insurance, improved customer relations, and safeguards to guarantee that people receive the full measure of the mental health coverage to which they are entitled by their insurance policies.
  • The services of Emergency Services Programs (ESPs) should be available to all.  To that end, all commercial insurers should include ESPs as an essential part of their behavioral health coverage.
  • The comprehensive approach to children’s mental health, embodied by the Children’s Behavioral Health Initiative (CBHI), should become a universal feature of commercial insurance.

Appendix: You can access the appendix documents here

Media Coverage: WBUR’s Morning Edition Broadcast: Oct. 13, 2017 (coverage of the report begins at 65:30)

Additional Resources:

If you’re having issues with coverage of mental health services, please call:

  • Health Law Advocates at (617) 338-5241
  • Division of Insurance (DOI) Consumer Services Unit at (617) 753-6830
  • Attorney General’s Office Health Care Division at (617) 830-6277 (for complaints about fully insured plans)
  • Department of Labor/Employee Benefits Security Administration (DOL/EBSA) at (866) 444-3272 (for complaints about self-insured plans)

For information on health insurance appeals, please call the Office of Patient Protection at (800) 436-7757.

If you’re having trouble accessing care or need help locating services, please call the National Alliance on Mental Illness (NAMI) Massachusetts helpline at (800) 370-9085.

For legal advice, please call the Mental Health Legal Advisors Committee at (800) 342-9092.


For more information on the project, please contact Natalie Litton at [email protected].


The project is funded by The Peter and Elizabeth C. Tower Foundation