"The majority of untreated people with serious mental illness do not believe they have emotional problems requiring treatment, and most of those who recognize they need help prefer to deal with the problem on their own," says lead study author Ronald C. Kessler, Ph.D., a professor at Harvard Medical School and at the Institute for Social Research at the University of Michigan.
An estimated 10 million Americans meet criteria for serious mental illness according to the study, published in the December issue of Health Services Research.
Efforts to reform mental health care tend to focus on barriers like not having the money for treatment or not knowing where to find treatment, says Kessler, arguing for a broader approach. "Overhauling the existing treatment system to reduce financial and situational barriers is unlikely, by itself, to reduce unmet need entirely," the researcher says.
Kessler and colleagues examined data from the National Comorbidity Survey, a household survey of more than 8,000 individuals age 15 to 54, designed to diagnose mental illness. About 6 percent of those surveyed had a serious mental illness such as panic disorder, post traumatic stress disorder, major depression, manic depression, schizophrenia or another mental disorder resulting in serious personal problems, work disruptions or suicide attempts or plans.
During the year before they were surveyed, 62.8 percent of the seriously mentally ill respondents received no stable treatment from a professional such as a psychiatrist or other medical doctor, nurse, psychologist, social worker or counselor, the researchers found. Of that population, 46.2 percent received no treatment and 16.6 percent dropped out of treatment.
A majority of the untreated seriously mentally illness individuals felt they did not have an emotional problem. Untreated individuals who recognized they had a problem most often said they would rather address their problem themselves than seek treatment. Other treatment barriers included not knowing where to find treatment, money problems and lack of confidence that treatment would help, the researchers found.
Kessler and colleagues noted that younger seriously mentally ill individuals (age 18 to 34) were heavily represented in the untreated category.
Contrary to previous research, Kessler and colleagues found rural individuals were more likely than others to receive treatment, and less likely to report stigma as a treatment barrier. "This finding clashes with the naïve notion that concerns about what the neighbors think are greater in rural than urban areas," Kessler says.
Kessler and colleagues note that their research didn't include homeless or institutionalized individuals, and their definition of serious mental illness was narrow--so their estimated prevalence of serious mental illness is probably conservative. Also, their study data were collected in the early 1990s, before the rise of new antidepressant and antipsychotic medications and of the managed care industry.
This research was supported by grants from the National Institute of Mental Health, the National Institute of Drug Abuse, and the W.T. Grant Foundation.
Health Services Research is the bimonthly peer-reviewed journal of the Academy for Health Services Research and Health Policy and is owned by Health Research and Educational Trust. For information about the journal, contact Alice Schaller at (510) 643-5439 or email alices@uclink4.berkeley.edu.
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