Introduction
Mental wellbeing matters for individuals, families, and communities in Minnesota. The National Alliance on Mental Illness (NAMI) estimates that almost 820,000 adults in Minnesota have a mental health condition, and that doesn’t include those struggling with mental health without a diagnosed condition.
Population health surveys such as the Minnesota Health Access Survey (MNHA) can provide information about health-related quality of life. Using the ‘Healthy/Unhealthy Days’ survey measures developed by the Centers for Disease Control (CDC) together with questions about health care affordability, this survey data can provide us with a snapshot of Minnesotans’ experiences with mental health and access to mental health care.
In this blog, we use data from the MNHA to better understand access to mental health care and mental health care affordability in Minnesota. We look at the scale of these challenges and what populations might be most impacted by unmet mental health care needs, and discuss the implications for communities, health systems, and health policy.
Study Design
For this study, we used data from the Minnesota Health Access Survey (MNHA). The MNHA is a biennial survey providing information about Minnesotans’ health and health care, including insurance coverage, barriers to accessing health care, and information on health care costs and affordability.
We pooled data from the 2021 and 2023 MNHA to understand Minnesotans’ experiences with mental health and to examine forgone mental health care due to cost. For this study, we included nonelderly adults ages 18-64.
Measures Examined in This Study
The MNHA asks respondents about their experiences with mental health in the past month. Specifically, mental health was assessed by a survey question which asked respondents:
“Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days in the past 30 days was your mental health not good?”
Our analysis looked at “Frequent Mentally Unhealthy Days,” defined as experiencing 14 or more days in the past month where a person’s mental health was “not good.” This measure has been shown to correlate with clinically meaningful differences in health.
To understand how affordability may impact access to mental health care, we also used data from the MNHA measure of Forgone Mental Health Care Due to Cost, where respondents indicate whether they needed but did not get mental health care due to cost during the past year.
For both of these measures (i.e., frequent mentally unhealthy days and forgone mental health care due to cost), we compared overall state averages for nonelderly adults to rates for subpopulations by age, gender, race/ethnicity, sexual orientation, income, and health insurance coverage.
Results: Frequent Mentally Unhealthy Days
One in five nonelderly adults in Minnesota – over 600,000 individuals - reported that their mental health was not good for 14 or more of the past 30 days (20.2%; Figure 1).
Figure 1. Frequent Mentally Unhealthy Days Among Adults (Age 18-64) in Minnesota, 2021 and 2023
We found significant variation in frequent mentally unhealthy days by age, gender identity, sexual orientation, income, and health insurance coverage status. Rates of frequent mentally unhealthy days significantly higher than the state average were reported by:
- Over half of transgender/nonbinary adults and bisexual/pansexual adults (54.3% and 50.5%, respectively)
- Nearly half of uninsured adults (47.8%)
- About two in five adults who identified as “none of these” for sexual orientation and adults with low income (0 to 200% of the federal poverty guidelines [FPG]) (42.5% and 38.2%, respectively).
- About one in three younger adults (age 18-34) and adults with public coverage (30.7% and 31.2%, respectively).
Rates of frequent mentally unhealthy days were significantly below the state average for older adults (age 35-54 and 55-64), cisgender men, straight adults, adults with incomes >200% FPG, and those with private coverage. We also examined frequent mentally unhealthy days for subgroups by race/ethnicity and found few significant differences (results not shown).
Results: Forgone Mental Health Care Due to Cost
Among all nonelderly adults in Minnesota, 13.0% reported that they needed but did not get mental health care due to cost in the past year (Figure 2). This represents over 400,000 people – and these statistics do not include children or the elderly.
Figure 2. Forgone Mental Health Care Due to Cost Among Adults (Age 18-64) in Minnesota, 2021 and 2023
Similar to our results for frequent mentally unhealthy days, rates for forgone care due to cost varied significantly for subpopulations by age, gender identity, sexual orientation, and health insurance coverage status. Rates of forgone mental health care due to cost significantly higher than the state average were reported by:
- Four in 10 transgender/nonbinary adults (39.1%)
- About one third of bisexual/pansexual adults and uninsured adults (33.8% and 35.6%, respectively)
- One in four gay or lesbian adults (24.4%)
- One in five younger adults age 18-34 (19.2%)
Two groups reported forgone mental health care significantly below the state average: older adults age 55-64 (5.3%) and straight adults (11.2%). We found no significant differences in forgone mental health care due to cost by income or race/ethnicity.
Discussion: Mental Health Needs and Access to Care in Minnesota
Overall, our analysis shows that mental health care concerns and cost barriers to accessing mental health care affect substantial numbers of Minnesotans. We found overlap in the populations reporting the highest rates of both of these measures, including young adults, people with minoritized sexual and gender identities, and uninsured populations. These results suggest that individuals with unmet needs for mental health care in Minnesota may have difficulty accessing it due to cost barriers.
Understanding disparities and population differences in mental health and health care access can help inform policymakers, community health workers, and others seeking to improve population health. Targeted efforts may build on local and community-based initiatives.
Our results may be a conservative estimate of mental health burdens and unmet needs across the population. Some individuals might experience clinically significant mental health concerns yet report fewer than 14 mentally unhealthy days in the past month, which would have excluded them from our estimate. Individuals with greater resources including education may be / have been shown to be more likely to perceive mental health access barriers. More generally, looking across all types of care (not just mental health care), nearly half of Minnesotans report forgone health care due to costs.
The nuances of measuring mental health access underscore the importance of having trusted health providers and receiving preventative care, including mental health screenings. Primary care may help connect people experiencing frequent mentally unhealthy days with supports and potential treatment options.
Mental health is an important consideration in policies to address health care access and affordability in Minnesota. Our analysis shows the importance of ongoing data monitoring and comprehensive policies to address evolving mental health care needs for Minnesotans.
Further Related Resources from SHADAC
If you’d like to better understand your state’s mental health landscape, SHADAC’s State Health Compare has a number of measures you can explore by state and subpopulation, including measures for ‘Unhealthy Days’ that use data from the Behavioral Risk Factor Surveillance Survey (BRFSS) for both mental health and physical health. These estimates are offered at the national and state level, including data as early as 2011.
Note: In contrast to the analysis above, which focuses on reports of 14 or more mentally unhealthy days in the past 30 days, the State Health Compare ‘Unhealthy Days’ measures tabulate the average number of days during the past 30 days when a person’s physical health or mental health was not good.
You can also explore a related mental health access measure, “Percent Who Saw or Talked to a Mental Health Professional in the Past Year” as well as the forgone care measure “Percent of Adults Who Could Not Get Medical Care When Needed Due to Cost.” Both of these measures are available by state and subpopulation.
For Minnesota, you can also use our Minnesota Community and Uninsured profile to dive into the uninsured population characteristics. This tool allows you to explore rates, counts, and demographics for the uninsured population in the state overall, by zip code, county, legislative district, and more. We’ve also created an interactive map to help visualize this information.