Mental Health Service Use and Equity in a Comprehensive Employer-Sponsored Benefit Program: A Retrospective Cohort Study

Abstract

Geographic and socioeconomic disparities in access to mental health care contribute to overall health inequity. Identifying scalable interventions that expand access to affordable and effective care remains a critical priority. This retrospective cohort study analyzed medical claims and census-level socioeconomic data from 742,658 individuals representing 90.9% of all US counties who were eligible for an employer-sponsored mental health benefit. Mental health service utilization was compared between individuals who accessed care through the benefit program and those who used the traditional health plan, across levels of socioeconomic disadvantage as measured by the area deprivation index. Program implementation was associated with a 36% relative increase in mental health care use overall compared to health plan utilization in the prior year. Following program implementation, care initiation increased equitably among program users, while disparities by area deprivation persisted among health plan users. Program users also had more equitable care retention and therapy duration across deprivation levels, whereas disparities increased among health plan users. Program initiation was positively associated with the number of employer-sponsored sessions, with a stronger association observed among individuals in high-deprivation areas. Lastly, program use was associated with significant reductions in anxiety and depression symptoms, with comparable treatment effects across deprivation levels. The benefit program was associated with more equitable care initiation and reduced socioeconomic disparities in engagement relative to traditional plans. Program users also experienced significant clinical improvements across deprivation levels. These findings highlight opportunities to reduce systemic barriers and promote equitable access to mental health care through scalable, real-world interventions.