This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network |
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This Web site is a component of the SAMHSA Health Information Network. |
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Unmet Needs and Barriers to CareMental illness is shockingly common, affecting almost every American family—directly or indirectly. It can strike a child, a brother, a grandparent, or a co-worker. It can strike someone of any background—white, African American, Asian American, Pacific Islander, Hispanic American, or Native American. It can strike at any stage of life, from childhood to old age. No community is unaffected, no school or workplace untouched. About 5-7 percent of adults, in a given year, have a serious mental illness, according to several nationally representative studies (DHHS, 1999; Kessler et al., 2001; NHSDA, 2002). "Serious mental illness" is a term used in federal regulations for any diagnosable mental disorder that affects work, home, or other areas of social functioning. A similar percentage of children, about 5-9 percent, have a "serious emotional disturbance," or SED. This term also comes from Federal regulations, and it refers to any diagnosable mental disorder (in a child under age 18) that severely disrupts social, academic, and emotional functioning. The annual prevalence figures translate into millions of adults and children disabled by mental illness. The disability toll can be quantified in a way that cannot be ignored: when compared with all other diseases (such as cancer and heart disease), mental illness ranks first in terms of causing disability in the United States, Canada, and Western Europe, according to a study by the World Health Organization (WHO, 2001). This groundbreaking study found that mental illness (including depression, bipolar disorder, and schizophrenia) accounts for 25% of all disability across major industrialized countries (Figure 1). In the US, the economy's loss of productivity from mental illness amounts to $63 billion annually (DHHS, 1999). The bottom line is that mental illness is very common and very disabling—and not to be dismissed as a character flaw or weakness. In the speech launching this Commission, the President said, "…Americans must understand and send this message: mental disability is not a scandal—it is an illness. And like physical illness, it is treatable, especially when the treatment comes early." There are many effective treatments for mental illness, according to the landmark 1999 report, Mental Health: A Report of the Surgeon General. With effective treatment, services, and the support of families, friends, and communities, the possibility of recovery is no longer elusive. "My experience was very positive. …I feel that my recovery from depression was due to the provider's flexibility in services." While many people are given good care and manage to recover, the reality is that about one out of every two people who needs mental health treatment does not receive it (Kessler et al., 2001; NHSDA, 2002). The individual who reaches care may find that many treatments and services are simply unavailable, especially in rural areas. Also, the quality of care may be inadequate. A diagnosis may sometimes be missed, the dose of medication may be insufficient, or the length of treatment too short (DHHS, 1999; Young et al., 2001). For ethnic and racial minorities, the rate of treatment is even lower than that for the general population, and the quality of care is poorer. After thorough study of the problem, the Surgeon General's report concluded that minorities, in comparison to whites, bear a greater burden from unmet mental health needs and thus suffer a greater loss to their overall health and productivity (DHHS, 2001). "Mental illness is an equal opportunity disease. Yet we are the expendable ones. If you are poor and female and minority - I'm African American … the system isn't operating as it should." The stigma of mental illness is also a major barrier to treatment. Many people are reluctant to seek care because of the shame our society attaches to mental illness. Societal stigma leads to ridicule, ostracism, and inexcusable discrimination in housing and employment. Stigma is often internalized by individuals with mental illness, leading to hopelessness, lower self-esteem, and isolation. Even more tragically, stigma deprives them of the social support they need to recover. "Stigma leads to isolation, and discourages people from seeking the treatment they need." This Commission has been charged to focus on the service system and to identify the barriers to getting services. Through its activities, the Commission has identified five barriers (Exhibit 1) that needlessly impede access to care within the mental health system. These barriers do not stand in isolation; tearing down any one of them has the potential to bring down some others. The heartening news is that the Commission has found creative, community-based programs that begin to circumvent the barriers. These programs carry a track record of success at achieving desired outcomes. Our review indicates that the best results are often achieved despite—not because of—financing systems and bureaucracies that often create fragmentation instead of focus and reward dependency instead of recovery. The system should foster recovery, resilience, and independence, not thwart them by limiting access to effective treatments. After a short description of the fragmented system, the Commission describes each of the exemplary programs. They range from school-based mental health care in Dallas to suicide prevention by Air Force generals. The Commission will consider the programs' implications and opportunities, along with other solutions, in its final report. Exhibit 1
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