Section 4: Underserved Populations
In interviews and focus groups, people identified populations underserved or particularly harmed by gaps in the mental health and substance use services system. Often these populations are experiencing complex and intersecting social, health, and financial challenges. The gap-related barriers they experience in seeking and receiving care vary.
This analysis identified populations that are underserved or harmed by gaps in the mental health and substance use services system.
- Children
- Young adults
- Elderly
- Formerly incarcerated
- Veterans
- Unhoused
Discussions of underserved populations focused on age groups with the greatest need and fewest resources (the youngest and oldest), followed by the complexity of needs, minority populations who cannot access existing resources due to language or cultural barriers, and compounding challenges faced by individuals and groups with multiple identities, such as homeless youth.
Interviewees identified concerns about young people (ages 0-25) falling through the cracks as most urgent because the quality of intervention is crucial during this time of brain development. Improving service to this age group may lead to a reduction in future demands on the mental health and substance use services system.
Young adults and elders with a serious mental illness, dual diagnoses, intellectual disabilities, aggressive behaviors, neurodivergence, complex post-traumatic stress disorder, or dementia were repeatedly mentioned as lacking appropriate treatment or support options. Workforce, treatment, and residential facility availability further diminish when people in these age groups are racial or cultural minorities, deaf or hard of hearing, gender expansive, undocumented, or do not speak English.
Children (age 0-17)
Workforce concerns for this population include an insufficient supply of child psychiatrists and outpatient providers who specialize in child mental health; a workforce unprepared to support children with intellectual or developmental disabilities, neurodivergence, substance use disorder, or aggressive behaviors; and a funding structure that doesn’t allow mental health and substance use professionals to be reimbursed for addressing issues resulting from neurodivergence like autism.
Some respondents stated that residential facilities refuse to serve these populations because they are too challenging, and that private insurance will not cover appropriate care for these populations because it is too costly. Without a focus on supporting the family unit, many young people are placed in child welfare or enter the youth justice system simply to access care. These options can result in increased trauma, decreased stability, and fractured families. These combined factors can push the young person in need onto a trajectory of chronic dependence on the public services.
Young adults (age 16-25)
Respondents noted how an insufficient supply of resources needed to build and preserve mental health across childhood persists into young adulthood. This can advance into the development of serious mental illnesses, substance use disorders, and the likelihood of being exploited by other people. The risks of this are noted to be particularly high for unhoused young people, and resources for serving unhoused young people were called out as particularly absent in Wisconsin's mental health and substance use services system.
Older adults (age 65 and older)
Respondents reported few resources devoted to preventing or reducing substance use in the elderly.
Respondents also reported bureaucratic challenges that make it difficult to meet the mental health and substance use needs of the elderly who have dementia. Several health care providers provided comments in the survey highlighting the challenges they experience when working with an elderly patient who has dementia alongside a mental health and substance use need, or who could benefit from psychotropic medications. Repeatedly, nursing staff shared that their requests for mental health stabilization services are declined because treatment staff did not feel equipped to work with an individual who has dementia. Instead of providing appropriate care, the nurses reported engaging the police to manage aggressive behaviors that endanger staff in their facilities, or of older adults being sent into long-term care units where their freedom is restricted, and the primary treatment is sedation, from which some elderly never recover.
Additional comments noted the current service utilization rate of those with dementia and other neuropsychiatric conditions and predicted an increase in future demand within this demographic.
Formerly incarcerated, veterans, and unhoused
Narratives from interviews and survey comments highlight additional groups facing system gaps in attaining well-being, including the formerly incarcerated, veterans, and the unhoused. Housing was a recurrent thematic barrier across many identities in getting services, as a foundational need to attain wellness and establish residency to initiate support.
Go back - Section 3: Findings - Gaps in the System
Next - Section 5: Causes of Gaps