Can We Bridge the Gap? 

Exploring Disparities in Mental Health and Substance Use Disorder Treatment Based on Income

In the serene landscapes of Colorado, a stark contrast exists in the realm of mental health and substance use disorder treatment. While the affluent can readily access a spectrum of services, programming, and resources tailored to their needs, the indigent population often grapples with limited options, especially when it comes to more intensive care such as intensive outpatient or inpatient programs. This divide sheds light on the profound impact of income on the accessibility and quality of mental health and substance use disorder treatment, affecting individuals regardless of gender.

The Affluent Advantage: My more prosperous clients often benefit from a plethora of mental health services that cater to their specific needs. Furthermore, they can afford to not use insurance and prefer to pay out of pocket to avoid a “paper trail.” Some clients still perceive shame around substance use disorder (SUD) and/or alcohol use disorder (AUD).  Therefore, if they have the means to pay privately, they will.  I have had clients, prior to working with me in private therapy and/or couples therapy, pay upwards of $60,000 per month for elite 30 day inpatient programs. The 1-2% have unlimited private therapy choices, offering a range of therapeutic modalities and personalized approaches such as Dialectical Behavioral Therapy (DBT), EMDR, and natural medicines like psilocybin. Access to renowned clinicians, specialized programs, and holistic treatment options contribute to a comprehensive mental health support system.

My affluent clients can explore a variety of rehabilitation facilities, each equipped with state-of-the-art resources and evidence-based practices.  All of this can lead to better outcomes and less recidivism. The resources needed for overall solid self-care are attainable when one has a large disposable income.  These fortunate clients can treat themselves to regular massages, acupuncture for alcohol cravings, trips to luxury hotels, babysitters for special dates, a private box at a sporting event where they control what is in their box, and enough therapy to maintain desired change.

However, as the economic divide widens, this access is a luxury that not everyone can afford.

The Indigent Struggle: For those relying on Medicaid for mental health and SUD care, the disparity in available resources becomes evident. While Medicaid provides a lifeline for the indigent, the options for intensive services are notably restricted. Limited availability of inpatient and intensive outpatient programs (IOP), coupled with a shortage of specialized clinicians, poses a significant barrier to comprehensive care.  I continue to accept Medicaid as I do believe that even as a seasoned clinician, I have an ethical responsibility to serve everyone regardless of economic class.  Not all my clinicians have this professional value.  The disparity I see is humbling, as a clinician I need to be creative as I navigate this aspect of capitalism, or our economic reality.

Gender Disparities: The impact of income on mental health and SUD treatment is pervasive, affecting both men and women. Gender-based disparities compound the issue, as women from lower-income brackets may face additional hurdles in accessing adequate care. While men who may have financial hardships due to expenses like child support or maintenance, may not prioritize treatment.  The intersectionality of gender and income can result in a double disadvantage, limiting the choices and quality of treatment available to women in need.

Closing the Gap: Addressing the disparities in mental health and SUD treatment requires a multi-faceted approach. Advocacy for increased funding and resources for holistic programming is essential to ensure that intensive services are accessible to all, irrespective of income. Collaboration between public and private sectors can lead to innovative solutions that bridge the gap between the affluent and indigent populations. By fostering a more inclusive and equitable mental health and SUD treatment landscape, we can work towards a future where income no longer determines the extent of one’s access to care.

In the breathtaking landscapes of Colorado, a hidden divide persists in the realm of mental health and substance use disorder treatment. This issue is not limited to one state, as most states also face this socioeconomic conundrum. I see clients from many states, often reflecting the above. As we strive for a more compassionate and inclusive society, it is imperative to recognize the profound impact of income on accessibility and quality of care. By addressing these disparities head-on, we can pave the way for a more equitable future where everyone, regardless of their financial standing, has the opportunity to achieve mental well-being and recovery.