8 Reasons Why People Don’t Get Treatment for Mental Illness

It’s probably no big surprise that many people with mental health issues don’t readily seek treatment for their concerns. But how widespread is this pattern?

A 2004 report by the World Health Organization reviewed rates of psychiatric treatment usage across 37 research studies. The findings are unbelievable. Between 30 and 80 percent of people with mental health concerns never receive treatment.

From this analysis, the average non-treatment rates for specific disorders were: schizophrenia (32%), bipolar disorder (50%), panic disorder (55%), major depression (56%), generalized anxiety disorder (57%) obsessive-compulsive disorder (59%), and alcohol dependence (78%). It’s also acknowledged that these rates are probably lower than the actual number of people failing to receive treatment.

Let those numbers sink in for just a minute. They show that more often than not, the majority of people who are dealing with real mental health issues don’t ever get the appropriate care they need.

Then the question that begs to be answered is “Why don’t people get help?” Let’s take a look at eight of the most common reasons that prevent people from obtaining needed mental health services:

1) Fear and shame 

One of the most common reasons for not seeking help is fear and shame. People recognize the negative stigma and discrimination associated with having a mental illness and don’t want to be labeled “mentally ill” or “crazy.” They may also have concerns about how such a label could negatively impact their career, education, or other life goals.

2) Lack of insight 

If someone has clear signs of a mental illness but says “there’s nothing wrong with me,” “I’m not sick,” or “I don’t need any help,” this signals a severe lack of insight. This is also known as anosognosia (uh-no-sog-NOH-zee-uh), seen in 50% or more of persons with schizophrenia or other severe mental illnesses. If someone truly believes they aren’t sick, they feel no need to seek or accept treatment.

3) Limited awareness 

A person may acknowledge some mental health concerns but can lack full awareness of their significance or really don’t understand they have an actual illness. They may dismiss or minimize their issues and say “everyone gets stressed out” or “my problems aren’t that bad” or “you’re making more out of this than you need to.”

4) Feelings of inadequacy  

Many people believe they are inadequate or a failure if they have to admit something is “wrong” with their mental health. Further, they believe they “should be able to handle things” on their own without assistance and that they must be weak or inferior to have to ask for help.

5) Distrust  

It’s difficult to consider revealing personal details to a doctor or counselor. Many express concern about “telling a stranger” about their problems. Additionally, they worry that their personal information won’t be kept confidential.

6) Hopelessness  

Some people have become demoralized by their mental health issues and believe “nothing will help me” or “I’ll never get better.” These beliefs can be due to depression or hopelessness, and can be substantial roadblocks to seeking help.

7) Unavailability 

Even if someone is interested in getting mental health treatment, they may not know how to find appropriate professional care. In some underserved areas, there may be few or no mental health professionals, particularly those who provide treatment for more complex issues.

8) Practical barriers

Another common barrier to mental health care is inability to pay for treatment due to financial hardship or lack of health insurance. Not having reliable transportation, child care issues and appointments for treatment that conflict with work or school schedules can also prevent someone from engaging in treatment.

Addressing the problem

Any one of these factors which delay or prevent appropriate care can be very difficult to overcome. To further complicate matters, several of these issues can often be in play simultaneously. These barriers are often even more pronounced among ethnic minority groups, older adults and individuals with less money or education.

Just as the issues are complex, solutions aren’t easy to find. Addressing practical barriers may be possible, by helping to arrange transportation, assisting with child care, or negotiating with employers to allow time away from work for mental health appointments.

The recent expansion in the US of mental health insurance benefits has opened up new care options for many people who were previously uninsured and who couldn’t afford to pay out of pocket for their treatment.

Availability of services can be a difficult issue to address, particularly in rural areas with few mental health clinicians. The increase of nurse practitioners as prescribers and programs which pay off clinicians’ student loans in exchange for their work in underserved areas have increased the number of trained providers in some regions.

The pronounced lack of insight seen in more severe mental illnesses is extremely difficult to change. One suggested approach to help improve insight is the LEAP (Listen, Empathize, Agree, Partner) model. After listening and empathizing with the person, mutually agreed upon goals can be identified and a partnership can be formed to help the person begin to achieve their goals.

Finally, many of the more “hidden” factors (fear, shame, inadequacy, limited awareness, and hopelessness) are challenging, because the person may function fairly well on the surface and can generally conceal their mental health concerns. If they begin to talk about these issues, they can then be encouraged to seek care to relieve their distress. Ongoing efforts to reduce stigma and discrimination are essential to send the clear message that it’s ok to talk openly about mental health issues and to ask for help.

Recently, legislation was passed by the US Congress that strives to address many of these issues, by improving access to care, promoting effective treatments and increasing services for underserved populations. While many details will need to be resolved as the components of this bill are put into practice, it could potentially benefit many individuals with mental illness and those who care deeply about their welfare.

For more on this topic, please see my recent post on overcoming these 8 barriers to treatment.

Here’s a question: What else can be done to address the problem of people not receiving treatment for mental health issues? Please leave a comment. Also please consider subscribing to my blog and feel free to follow me on Twitter, “like” my Facebook page, or connect on LinkedIn. Thanks!

 

  • Sandy Kilpin-Miller

    Can relate.

  • Sharon Jennings

    Stigma, stigma and more stinking stigma. We who are and have been getting treatment need to speak more openly about it…..

  • Bob

    I recognize I need help of some sort. I have even begged for it from the people in my Church, but they just ignore me and refuse to speak with me which is just making me worse. They seem to just be interested in playing games with me.

  • Ken Johns

    I agree Sharon. Those of us in recovery need to speak out and advocate to end the stigma.

  • Ginny

    Staying on meds is a problem, due to weight gain, and not being able to feel like your old self, no motivation. Trying to lower the dose, before the patient stops taking it altogether. Needs to be addressed more.

  • Faylinn Byrne

    Growing up, I never allowed my parents to seek mental health help for me. I grew up in the foster system and learned to never trust adults, especially those who had any type of authority. After I was adopted, however, my parents tried to take me to different types of therapists and I would refuse to talk. Now that I am an adult, I have grown to trust more and have even allowed myself to see a psychiatrist when I have felt like discussing the past. It has been very helpful and so I would encourage anyone who is struggling to trust to really work on being able to and to not give up on themselves. http://www.weberpsychotherapy.com/index.php?Page=SATT.htm&Section=Substance%20Abuse%20Treatment%20Team%20(SATT)&InSubMenu=OurServices

  • James Bergman

    I can relate to the shame that is associated with seeing a psychiatrist. I have some anxiety issues, not bad, but enough that I needed some extra help. However, I didn’t want to admit that I had any problems because to admit it meant that I was inadequate and worthless. Neither of which is true. It is just hard to overcome. I wouldn’t have if my wife hadn’t noticed and helped get my first appointment set up. I have to say, treatment is not nearly as bad as I thought. I actually kind of enjoy going, and it does help. http://www.commonwealthaffiliates.com

  • Faylinn, thanks so much for sharing. I’m glad things have gotten better for you and that you have found therapy helpful.

  • James, so glad to hear that you are benefitting from treatment. Hope things continue to go well for you.

  • Faylinn Byrne

    I couldn’t agree more. Thank you for the reply and for the article!

  • Josephine

    I am fairly private. Sought help and followed all advice. Recently an inpatient, involuntary. Not a big talker and this is why they held me. No treatment or plan. No involvement. Quotes from my private psychiatrist. And now I am meant to trust? Worse, I was forced to get friend involved and two weeks from work. No one would listen or talk to me outside the tree times a week interrogation where shock tactics were the go to get me to react. I now want to withdraw from all treatment in fear of being called unwell.

  • I’m so sorry you have had these very difficult challenges. Please don’t give up. I don’t know where you live, but if you have a local NAMI or Mental Health America (MHA) chapter, please consider giving them a call to access some additional support. Consulting with a different treatment provider for a second opinion is also often helpful. Take care.

  • Josephine

    Thank you, I am looking to more constructively be involved in the direction of my treatment through looking in to alternative or complimentary treatment. I feel this may allow me more choice, wider sources of advice without losing or ignoring the treatment history I have received to date. One foot in front of the other.
    With thanks

    Jo

  • Lillian Schaeffer

    This is some great information, and I appreciate your point that someone minimizing their issues can be an obstacle for getting mental health help. My son has been having problems with anxiety, and I think it would be beneficial for him to get professional help, but he doesn’t think his problems are that bad. What do you recommend doing to overcome this obstacle so he can get the help he needs? Thanks for the great post! http://novapsy.com

  • Hi Lillian,
    Yes, it’s extremely difficult to convince people to get professional assistance. A very nice book on this subject is “You Need Help!” by Mark Komrad. I think you might find it relevant to your situation. Hope everything turns out well for you and your son.

  • cherterica milam

    How did you find the courage to tell them you need to see one, I know I should see a Dr. But I have so many fears what if the voice gets louder what if a Dr can’t see anything wrong what if my family makes fun or worse dont believe me. I probably sound stupid but these are my fears and I want to over come them.

  • Just remember that mental health providers can be very helpful but only if you give them a chance and go see them. Also, if the first one isn’t a good fit you can always visit a different one. It’s often helpful to take a friend or family member with you to the first visit for support. Hope this helps.

  • YZ Doo

    I have had menTal health issues since I was 18 before the pharmaceuticals came up with
    marketing and a billion dollar marketing and false approval testing FDA for all new
    antidepressant drugs SSRIs etc they are all by now or will prove false as you can look up lawsuits against Zoloft etc.. And the proven now stated by them they can’t prove they are a s effective as a sugar pill. Lol it took me along time to swallow this since I based my mental health all on pills. I now take care of my mental health issues in a variety of ways meditation and a harsh prescription of hard physical exercise for anxiety and a strict diet of healthy foods and various support groups for depression and yes that means going to them especially when you don’t want to. By this I mean do it, I have been face down for months in a deep dark depression I know what it feels like and gues what the pills you are taking for so called antidepressants aren’t effective they are as effective as a sugar pill read about it for yourself. Here’s one article I just googled in regards to a few specific antidepressant drugs or add ons http://center4research.org/child-teen-health/general-health-and-mental-health/seroquel-is-widely-used-but-with-dangerous-side-effects/ look up,any other ones for yourself you can do it don’t be scared maybe your new antidepressant can help you be brave and do the research .
    Im a survivor of the Bullshit psychiatrists get paid very well to taught these falsely called antidepressant anti anxiety drugs I used to be on them and bet my life that I could not go on without them. Ne smart don’t just quit them if your taking all these dangerous drugs tell your psychiatrist you want off and the safest way to do that and then get a second opinion from an actual real doctor too.
    I may seem bitter because Im and proud and strong and healthy . Yes I see a good real life counselor yea I excersice now like it was a precipitous yes I meditate and actively practice mindfulness for emotional balance and yes I really get angry when I see any article that is saying to seek a,Psychiatrist when it is for anything that is not schizophrenia or true manic depression and not the new horse shit about varying degrees of mood disorders and yet a new medicine based treatment for real life emotions that some people have (wow so now that the proof is out that antidepressants aren’t effective everyone now will be treated for a mood disorder that entails all new and old medications to treat a made up disorder so psychiatrists and PhD authors that can’t and never quite made it as a real doctors so they became psychiatrists can make a lot of money again.) so yes I have issues and get angered and rightky so because I felt the pain and I’ve been in a metal hospital and again all they did was give me different pills and all because I was depressed and thank god I can have depression now and I am fully aware of what it feels like and I what I need to do to treat it naturally without pills that make it worse in time. So if you truly seek help please make sure you read carefully the new research of what is really proven effective and think really hard about our forefathers and mothers do you think they were depresed hell yea and they were not a spoiled lazy society that we are because they had to survive or die we now in our time have time to sit and relax and enjoy and the luxury to wish to much and have to much and the Id,e thinking is what kills us all is too much time and thought.
    Anyway just my 2 cents about yes the very important nature of mental health issues and my take on what truly works for me and I hope,everyone finds their own path and always keeps a mindful eye on their mental and key on their physical health as well, I think we shall be seeing in the next ten years true biological and real physical and true scientific tests that cause many symptoms such as depression and anxiety. Hold on and be well in all aspects of your lives.
    Peace

  • Linda Ambrose

    diagnosed with MDD over 30 years ago. Medications don’t help. I have had many ECT treatments which offer temporary relief. I no longer can emotionally deal with having frequent ECT treatments to treat this unrelenting illness.

  • Linda, I know severe depression can be very difficult to treat effectively in some cases. Sometimes it can be helpful to get second opinions from different health care providers about new and emerging treatment options. I hope you can find some relief and solace.

  • Thanks for sharing your views and I’m glad you have found some effective strategies that have helped you feel better.

  • Melinda Ballard

    I have been diagnosed with ADHD, GAD, MDD from a physiatrist. Unfortunately due to lack of health insurance and lack of money, I wasn’t able to continue going to follow ups to get my medication regimen straight. I’ve recently seen 2 primary care doctors and they both treated me as if I were lying. I don’t know what to do and I feel hopeless. I’m physically dying inside. Any suggestions?

  • Melinda Ballard

    Only medication I’m taking is Prozac and it does nothing for me.

  • Suchi Suchitra

    Anyone will you please help me

  • Juan

    Speaking as someone who is mentally ill but doesn’t see myself as the problem, I have to say that it hurts to know people immediately assume I have limited awareness. 🙁

  • Hi Melinda. While I don’t know your location or all of your circumstances, it’s sometimes helpful to reach out to a local NAMI chapter through http://www.nami.org, as they are often familiar with local resource options and how to navigate the mental health system. I hope you find the help you need.

  • Juan, I hope people don’t automatically assume you have limited awareness of your concerns, but I do know that sometimes happens. I’m hoping you can connect with some trusted friends or family members and some competent health care providers to help you get your needs met.

  • Kelli Ralynn

    I have been sexual abused/raped most of my life, all of my childhood and I know 110% that I have homicidal rage and suffer from anxiety PTSD. Even a psychiatrist told me, but they said they didn’t like diagnosing people and I didn’t receive any serious help, acknowledgement, meds, nothing. They will NOT take people seriousness. I go in when I have a clear mind because it’s the only time I can talk and actually feel comfortable. They expect to see me at my worst. But no, I NEVER leave my home, never, I don’t work, I can’t. And they think I’m being lazy, when really I fear so much!!! So much gets under my skin, triggers me, brings me down, etc. And I may come across nice an harmless but I am homicidal and it’s shown all of my life. But still….Nothing. When I was in foster care, from age 12-17 I went weekly, few times a week to different therapists and psychiatrist and talked to so many different people, and nothing. I mean… When we eventually mess up and harm someone or ourselves, then what? Send us to prison and punish us or pretend to care once we’re gone, what? Huh?

  • Kelli, I’m so sorry you have had these difficult experiences. It’s often helpful to reach out to groups like NAMI or Mental Health America for support and how to connect with potentially useful resources in your area. I hope things begin to improve for you.

  • Flyingwaffle1012

    People don’t get mental health treatment because most doctors go to answer is to play Dr Frankenstein woth someone’s head by goving them a pill which may make things worse….may not. At the end of the day, it is your family and friends, as well as yourself, who suffer. Not the good doctor. Then, after you’ve gotten so bad that everyone has left you, they offer to stick you in a hospital, where you are not listened to, and are invalid. People scream, some are scary, and there is no way to escape. If you act uncomfortable because of this, they think youre just being unreasonable, because hey, look at where you are. THAT is why people DON’T seek treatment.

  • I’m very sorry you’ve had these really upsetting experiences. I do know there are a number of caring therapists out there so I hope you can continue to explore other options to help you with your concerns. If you have a local NAMI or Mental Health America chapter, they are great resources.

  • Cynthia

    I recently saw a Psychiatrist who was a bully. He didn’t care about the patient he only did what he wanted to do.
    I cried every time I left his office and he would judge me calling me “Extra Sensitive “.
    His name is Dr. BOB Kalani in Commack, N.Y. never see that man he does not help he only hurts.

  • Eve

    When a public figure in the person of Prince Harry opens up to share his personal life experience of mental health, this supports the saying that, ‘You don’t have to be mentally ill to experience mental health issues’. Creating enabling environments for people to speak up about it without fear of reprimand or stigma is the first step towards encouraging recovery. The day-to-day business of ‘Life’ in itself leaves us all vulnerable to diverse challenges, and a mental break down will be the result of total overwhelm and reaching a tipping point. More resources (both public sector and private) should therefore be made widely available and easily accessible to the public.

  • Eve

    Dear Dr Susman, its really kind of you to open this platform for discussion. I’m interested in the recent unfolding of the role of nutrition and mental health. While i fully appreciate its a recent concept and that requires more detailed exploration I attach here a link to Dr Julia Rucklidge’s introduction to this topic.
    https://www.youtube.com/watch?v=3dqXHHCc5lA

  • Agreed!

  • Benni

    There are other reasons to add to this list. Having had severe OCD all my life, Ive been through all the hoops more than once with medication, and ‘therapies’. None of which have helped other than drugs, which eventually left me with serious and permanent side effects including hyperacusis and tinnitus. My ears are now so senstive to noise Ive had to have earplugs made just to go out for groceries. It has ruined my life. So now I have WORSE OCD, and symptoms I never had pre-drugs; I have learned about something called ‘protracted withdrawl syndrome’ which can last for up to four years… giving all manner of psychological and physiological problems – many of which were previously never even there! Im currently in the throes of this syndrome, having had to abandon medication two years ago. Dante’s inferno is nothing compared to what ive been going through!! Thank you SSRIs.

    The psychologists have usually been condescending and a little cold; and never truly listened to what I said. I really wanted to try psychoanalytical psychotherapy but alas it is no longer available on the NHS and I cannot afford to pay privately. After exhausting everything the NHS did not try to find this for me, they simply said ‘we don’t do it anymore’. I kept trying more CBT, more counselling, eft, hypnosis and exposure therapy, only to be much worse afterward; and very disheartened and depressed.

    I explained to all of the top people in the NHS psy dept how I feel psychoanalytical would really work for me and why; (my issues stem from major childhood issues which I still havent been able to address, and Im now nearly 50) but I just hit brick walls every time.

    I tried to be really proactive, writing to every psy dept I could find and pleading with them… use me on trainees… let me be a guinea pig… anything. Here I am, knowing what I need and unless I win the lotto I will die like this. It is not as if my type of therapy costs any more than CBT! Sigh…
    It has been one hell of a battle. And peeing in the wind… lol (Glad I somehow managed to keep my sense of humour!!)

  • It sounds like your journey has been very, very difficult. I’d like to think you still might find the help you need and that things can begin to get better over time. Thanks for sharing your thoughts.

  • disqus_2WE5eZrg16

    I’m extremely wary of seeking treatment because, like #2, I don’t think anything’s wrong with me. I feel perfectly fine. But then I’ll have a breakdown or feel terrible or want to die and be reminded that there is something wrong…. Aaaaand it all starts all over again. It also doesn’t help that my episodes usually happen in private and never at the therapist’s office.

    Also, I’ll read about other people’s illness or see someone have a genuine panic attack, and I convince myself again that there’s nothing wrong because my problems are surely nowhere near as bad as theirs.

  • I certainly understand your point of view. When folks have periods of pretty considerable distress, talking with a professional is usually very helpful. One strategy is to go in for an initial visit and see if it helps, particularly when things aren’t going so well. Thanks so much for your comment.

  • $251524139

    I was forced by my parents to see someone (very respected in the field) for ADD. She twisted my words and belittled me, then diagnosed me with depression. The antidepressants she prescribed had terrible side effects. I got off them with the help of another professional, but if I did experience a real problem I think I’d be very wary of seeking “help” because I’ve been burned before.

  • Ted

    Some of the mentally ill are thrown out of doctors offices because of behavior. Can this be considered discrimination?

  • Ted

    If you have problems with anemia (ferritin) it could be caused by risperdal

  • I’m so sorry you had this negative experience. Please remember that there are many compassionate health care providers and consider giving treatment with a different person a chance if you continue to feel distressed.

  • In my view, everyone should have access to treatment if they want it. If someone threw me out of their office, I certainly wouldn’t want to go back to see them!

  • Sarah Stark

    I grew up with a mentally ill mother and now as a adult I am having my own issues with mental illness. I have been to 5 psychologists in my life and they were all various levels of unhelpful. I once visited a psychiatric hospital and spoke truthfully about my life but was not believed. It is incredibly hard for me to even call a psychiatrist to make a appointment, 6 weeks ago I hit a low that was so bad that I called a bunch of psychiatrists and all of their secretaries told me that either “they aren’t taking new patients” or “don’t have a open space for a appointment for months” I fear losing my identity to anti depresants, I fear the side effect of anti depressants, I fear the fact that I am already a slow person with no energy and the anti depressants will make things worse.

  • I’m very sorry you have encountered these difficulties. All I can say is that it is possible to find competent and caring mental health providers although sometimes you do have to go and meet them and to see if they are helpful and can meet your needs. Also it’s often helpful to contact NAMI or Mental Health America local or state chapters to get recommendations for good provider options. Please keep trying to get the help you need.

  • michaelBrodsky

    I am kind of wrong. I am a sociopath who plays with other people feelings and lives just for fun. I see at as wrong but still doing it. I never hurt people physicaly, but psychologicaly i like to play games. I dont want to do it, but my other half enjoys it. And the third part wants help not to think like that. And this is third part writinf probably. I dont know..is there somethinf wrong with me?

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  • Trixie Baldwin

    What about those of us who do ask for help and have to keep asking and keep asking to no avail? At this point I’m simply convinced there’s no hope for me, so why bother?

  • Trixie, please don’t give up hope. I don’t know where you live, but consider reaching out to mental health advocacy groups like NAMI or Mental Health America or peer support groups to assist you in finding other options for getting help.

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