Mental Illness Treatment Still Elusive for Many

Almost half of all Americans (46 percent) will meet criteria for a DSM-IV disorder sometime in their lifetime.

“The public and policymakers need to realize that the high prevalence is not surprising,” Harold Pincus, M.D., executive vice chair of psychiatry at the University of Pittsburgh and one of the survey authors, told Psychiatric News. “All you have to do is think about the people you know—family, friends, neighbors, coworkers—and how many of them go through some significant emotional turmoil over the course of their lives.”

Mental disorders usually have their onset in childhood or adolescence. Such early onset, the researchers wrote, is “opposite the patterns found for almost all chronic physical disorders.... Whatever else we can say about mental disorders, then, they are distinct from chronic physical disorders because they have their strongest foothold in youth.”

Although mental disorders are widespread in the U.S. population, the most serious ones are concentrated among a relatively small proportion of cases. Of cases that occur during a 12-month period, about 22 percent can be classified as serious, 37 percent as moderate, and 40 percent as mild. Twelve-month cases were classified as serious if they had any of the following: a suicide attempt with serious lethality intent; work disability or substantial limitation due to a mental or substance disorder; positive screen results for nonaffective psychosis; bipolar I or II disorder; substance dependence with serious role impairment; an impulse-control disorder with repeated serious violence; or any disorder that resulted in 30 or more days out of role in the year.

While the vast majority of people with lifetime psychiatric disorders eventually receive treatment, the delay in doing so can be long, on average six to eight years for mood disorders and from nine to 23 years for anxiety disorders.

Survey respondents who had a mental disorder that met DSM-IV criteria during the preceding 12 months were asked about any mental health treatment they had received during that time. Only 41 percent reported receiving treatment, and only about one-third of those were classified as having received at least minimally adequate treatment. Minimally adequate treatment was defined as receiving either pharmacotherapy (two months or more of an appropriate medication plus four or more visits to some type of physician) or psychotherapy (eight or more visits with a health care professional lasting on average at least 30 minutes).