I’ve written several times about the important issue of the need for affordable and effective treatment for mental health issues.
I’ve also thoroughly discussed several of the main reasons why large numbers of people get little or no treatment for mental illnesses. Two of my most popular posts on this topic are “8 Reasons Why People Don’t Get Treatment for Mental Illness” and the follow-up piece on “Overcoming the 8 Reasons…”
Since it’s been a while since I last visited this topic, I was eager to review some of the recent data on this issue from the 2016 National Survey on Drug Use and Health (NSDUH), published by SAMHSA (Substance Abuse and Mental Health Services Administration). This large scale national survey looks at several key indicators related to mental health and substance abuse treatment across the United States.
The survey found that an estimated 11.8 million adults aged 18 or older had a perceived unmet need for mental health care in the past year, including 5.5 million adults who did not receive any mental health services in the past year.
The survey then reported specific reasons why these adults had not received any mental health services in the past year. Here are the responses, and each person could offer more than one answer:
Top reasons for not receiving mental health services in the past year by adults age 18 and over who did not receive mental health services (NSDUH, 2016):
- 37.2% Could not afford cost
- 31.0% Thought could handle the problem without treatment
- 26.0% Did not know where to go for services
- 21.7% Did not have time
- 12.6% Might cause neighbors or community to have negative opinion
- 11.9% Health insurance does not pay enough for mental health services
- 11.9% Concerned about being committed or having to take medicine
- 11.9% Did not feel need for treatment at the time
- 11.7% Might have negative effect on job
- 11.0% Concerned about confidentiality
- 10.0% Treatment would not help
- 9.1% Did not want others to find out
- 8.8% Health insurance does not cover any mental health services
- 3.8% No transportation or inconvenient
Now let’s take a look at this list in a different way. It seems that all of the reasons can be grouped into three larger categories:
1) Cost and other practical barriers
- Could not afford cost – 37.2%
- Did not have time – 21.7%
- Health insurance does not pay enough for mental health services – 11.9%
- Health insurance does not cover any mental health services – 8.8%
- No transportation or inconvenient – 3.8%
This category shows how the high cost of health care and the lack of adequate health insurance for mental health issues are still huge barriers to treatment. Also striking is the large number of people who “did not have time” to seek mental health treatment. In future studies, it would be helpful to obtain further detail about the components of this barrier.
2) Lack of insight, awareness and information
- Thought could handle the problem without treatment – 31.0%
- Did not know where to go for services – 26.0%
- Did not feel need for treatment at the time – 11.9%
This group of reasons gets at the issues that many people may not appreciate the seriousness of their mental health concerns or may feel that they should be able to cope without obtaining treatment. (Remember that chronic lack of insight is often a symptom associated with serious mental illnesses.) It is also very concerning that a large group report they did not know how to locate appropriate mental health services.
3) Distressing thoughts and feelings (stigma, fear, distrust, hopelessness)
- Might cause neighbors or community to have negative opinion – 12.6%
- Concerned about being committed or having to take medicine – 11.9%
- Might have negative effect on job – 11.7%
- Concerned about confidentiality – 11.0%
- Treatment would not help – 10.0%
- Did not want others to find out – 9.1%
This group clearly shows the ongoing pervasive influence of societal stigma and discrimination around asking for help for mental health issues, admitting you have a mental illness, and worries about how disclosure of the illness will be received by friends, family, and co-workers.
Overall, these three categories are remarkably similar to the 8 reasons I had outlined in my earlier posts. However, I believe this grouping of three main areas of concern is simpler and easier to remember.
I’ll suggest a simple memory aid (Let’s help people get out of the “CoLD”!) to remember the three main categories of reasons why people don’t get the mental health services they need:
Top Reasons Why People Don’t Get Needed Mental Health Services
(Let’s help people get out of the ‘CoLD’!):
Co = Costs and other practical barriers
L = Lack of insight, awareness, and information
D = Distressing thoughts and feelings (stigma, fear, distrust, and hopelessness)
I think it’s imperative for us to continue to discuss these reasons which keep people from getting needed mental health treatment and work together to develop solutions which will reduce these barriers and improve access to care.
Here’s a question: Which of these reasons have kept you or a loved one from receiving needed mental health services? Please leave a comment. Also, please subscribe to my blog and feel free to follow me on X (formerly Twitter), “like” my Facebook page, or connect on LinkedIn. Finally, if you enjoyed this article, please share it with a friend!