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There have always been concerns about the mismatch between individuals' need for mental health care services and their actual use of those services. This mismatch is thought to be a result of complex social forces that affect the ability to access care, including people's beliefs, their ability to find places to go and people to consult, the nature of the health care system itself, and the influence of insurance coverage. In the United States, we are undergoing important changes in all of these forces; most importantly the passage of two major pieces of legislation that are designed to improve equal access to care for people with mental health problems. In this chapter, Pescosolido and Boyer introduce the new laws, describe the complicated medical issues in getting both physical and mental health care for people with mental illness, and review medicine's response. To face these challenges, the chapter provides an overview of the most important theoretical models that sociologists use to understand utilization, and suggests new questions that are raised by contemporary changes in the landscape of care. How can we understand why people with mental health problems do or do not enter into care? How might the changes under recent health care reforms affect use of mental health services?
Introduction
The Patient Protection and Affordable Care Act of 2010 (ACA; full activation in 2014) and the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA; full activation in 2010) provide significant opportunities for expanding mental health treatment and addressing the highly fragmented system of care for persons with serious and persistent mental illnesses (Mechanic, 2011). This is significant, especially for individuals with severe mental illnesses. They have a significantly higher risk of comorbid medical disorders including diabetes, hypertension, heart disease, asthma, and gastrointestinal disorders, than those without a mental illness (Dickey, Normand, Weiss, Drake, & Azeni, 2002). Yet, gaps in quality of care for those with severe mental illnesses exist in both the primary care and specialty mental health settings (Miller, Druss, Dombrowski, & Rosenheck, 2003).
Directives under the ACA call for greater integration of services both by bringing specialty mental health care into primary medical care settings and by offering primary medical care for co-occurring medical disorders within the specialty mental health sector (Raney, 2015).
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