Mental health in the Cape Fear: Part three, who needs help, and how do they get there?
New Hanover County residents making less money more frequently reported having poor mental health. That same demographic can also have a harder time literally accessing mental health care due to a lack of personal or public transportation.
What does the need in New Hanover County look like?
Roughly 1 in 4 respondents to New Hanover County's 2022 Community Health Needs Assessment survey reported having fair or poor mental health; the annual report is put together by the North Carolina Institute for Public Health.
Those making less than $50,000 reported having “poor” mental health at a higher percentage — 10.9% as opposed to only 4.5% for those making more than $50,000. The same group was less likely to report their mental health as “very good” by nearly ten percent.
It’s clear regardless of income, that mental health services are needed.
However, those making less than $50,000 were more likely to experience more hurdles while seeking care. High costs and Medicaid or other insurance not being accepted were an issue with approximately 10% more people in this income bracket versus higher ones.
Access to healthcare is not just about the proximity and availability of services. Access also literally relates to people’s inability to get to services — that is, a lack of transportation.
5.2% of lower-income respondents had no way to get to appointments as opposed to only 1.2% for higher-income respondents, and the former were more likely to not know where services were provided.
Physical access and transportation to medical facilities
Doctors in our region have noted that in more rural areas of the south, it’s more common to see patients with disease further along, requiring more intense treatment. This is in part because of how inconvenient it is to get to a hospital.
According to NAMI, “compared to suburban and urban residents, rural Americans must travel two-times as far to their nearest hospital” and “are two times as likely to lack broadband internet,” limiting access to telehealth. No personal transportation, limited public transportation, and expensive ambulance trips make going to health professionals nearly impossible for many.
It’s a common joke to talk about severely injured individuals driving themselves to EDs, but it’s rooted in truth. GoodRx reports the average charge for an ambulance ride ballooned 22%, to $1,277, between 2017 and 2020 before insurance or discounts.
Private health insurance companies typically provide at least some coverage for ambulance rides, but it depends on the reason for the transport. Most private health insurance plans cover medically necessary ambulance transport.
Congress passed the No Surprises Act, which went into effect in 2022, as a way to reduce unexpected medical bills but ground ambulance rides aren’t included under the law.
Medicaid pays for emergency ambulance rides by licensed ambulance companies. It also covers non-emergency medical transports when there is an order from a physician.