Poll: Mental Health Care Goes Mainstream

But many Americans who need treatment are not getting it

Karen Pallarito

Karen Pallarito

Published on May 07, 2004

WEDNESDAY, May 5, 2004 (HealthDayNews) -- An estimated 59 million people, or more than one in four U.S. adults, have received some form of mental health treatment in the past two years, a new poll finds.

It's a surprisingly large number, a sign, perhaps, that seeking help for a personal, emotional or mental health problem no longer carries quite the stigma it once did, according to the survey's sponsors.

The vast majority of these people -- an estimated 48 million -- are being treated with prescription medication. Drugs are clearly the dominant form of mental health treatment in America, the survey found.

"I think the improvements in medication are clearly a reason why a lot more people are getting help," said Jo Colman, publisher of Psychology Today magazine, one of the survey's sponsors. "It's really good that it brought people out to confront the issues that they're facing."

"It suggests to me that mainstream America has embraced mental health treatment," added Dr. Jerry Vaccaro, president and chief executive officer of PacifCare Behavioral Health, a co-sponsor of the survey.

But not everyone who needs care is getting help. More than a third of those who experienced sufficient distress to warrant care have not received it, the poll found. That's an estimated 24 million people, or nearly one in 10 U.S. adults.

Among the top reasons for not getting treatment are cost and doubt about its effectiveness. Thirty-nine percent said it's too expensive. Thirty-two percent said they didn't think it would help. In addition, 35 percent felt their troubles were not serious enough to warrant professional attention.

What's more, 43 percent believe the costs usually outweigh the benefits of therapy. Only 11 percent said the benefits outweigh the costs.

Andrew Sperling, director of federal legislative advocacy for the National Alliance for the Mentally Ill (NAMI), said many people who are not getting care face barriers to mental health coverage. Due to a persistent lack of parity with medical benefits, people with mental health problems often encounter treatment limits or higher cost sharing, he said.

To remove those obstacles, NAMI is urging Congress to pass mental health parity legislation sponsored by Sen. Pete Domenici (R-N.M.), whose daughter suffers from mental illness.

The poll, conducted by market research giant Harris Interactive, is said to be the first of its kind to measure how consumers think and behave when it comes to mental health treatment. The findings are based on a nationwide telephone survey of 501 adults and an online survey of 1,731 adults who needed or received mental health treatment within the previous two years.

Pollsters defined therapy broadly to include regular, one-on-one or group visits with a psychiatrist, psychologist, social worker or marriage and family therapist.

"The reason we went into this initially was because there simply isn't the data out there," Colman explained.

The survey included a unique tool for assessing consumers' distress levels and need for therapy, yielding the kind of benchmark data that Vaccaro thinks is sorely lacking in the mental health field.

"Imagine your internist saying, 'I just have the feeling that your blood sugar is a little high. I'm going to put you on insulin,'" he quipped.

The poll results point to areas where mental health providers need to improve care. For example, it shows a clear bias toward medication, even though talk therapy has been shown to be as effective alone or with medication for many patients.

Eighty-one percent of those with a treatment history have taken a prescription. Nearly half have used medication alone. By contrast, 53 percent have used psychotherapy, and 19 percent have used psychotherapy alone.

And while the shame of mental health treatment may have lessened, it hasn't disappeared entirely. More than one in five people who need therapy but haven't gotten it say it's because they fear it would go on their record. Almost one in five are afraid a friend or family member would find out.

Men are twice as likely as women to claim they don't want to be associated with the types of people who need therapy and to say that they don't trust therapists, the poll found.

All of that suggests that more needs to be done to spread the word about the effectiveness of treatment and teach clinicians and consumers about the value of talk therapy as well as medication, the sponsors concluded.

PacifiCare Behavioral Health, for example, is looking to extend its suite of "teleweb" services to give consumers the option to receive counseling via their telephone or their computer for a broader range of problems.

Such services may improve outreach to single parents who claim the cost of care and the difficulty of getting appointments at convenient times are barriers to seeking treatment.

Another potential obstacle is a lack of good information for choosing a therapist. In the survey, people ranked a therapist's listening skills and personality among the most important factors in making therapy successful. Yet the choice of a therapist is often based on a doctor's recommendation, their health plan's network of providers, or the therapist's location.

"The survey shows a clear disconnect between the ways people are finding a therapist and the factors that they should bring into their search," observed Colman, whose magazine offers a free online therapist directory.

If it's not you who needs help, maybe a family member of friend could use the name of a good therapist. These days, many Americans know someone who has been in treatment, or they believe their closest associates and kin could benefit, the poll found.

In fact, 40 percent of adults say their parents would have benefited from therapy.

A case of the pot calling the kettle black? "Make of it what you will," said Colman, who noted a serious side to that statistic. "A lot of people think they grew up in dysfunctional families."

More information

Psychology Today's free online therapist directory lists more than 20,000 licensed professionals, while the Substance Abuse and Mental Health Services Administration's National Mental Health Information Center has tips for choosing a mental health therapist.

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