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U.S. Lags in Treating Mental Illness

Posted on: Tuesday, 6 May 2003, 06:00 CDT

By Adam Marcus, HealthScoutNews Reporter

HealthScoutNews -- The United States has a greater percentage of mentally ill citizens than some other countries but typically provides less treatment for their problems, new research has found.

The study, which compared five nations in the Americas and Europe, found the United States had the highest prevalence of people who report some form of emotional trouble, at nearly 30 percent.

Although most of these were mild disorders, only a third of people in the United States with serious mental illness received treatment, the worst rate among the countries studied.

The findings appear in the May/June issue of the journal Health Affairs.

David Duncan, a Kentucky psychologist familiar with the research, says the results aren't surprising, given that the other four countries have national health insurance programs while the United States does not. "It shows the ways in which different health-care systems can have an impact" on treatment for mental disorders, Duncan says.

However, no nation in the study can claim to be doing an excellent job with their mentally ill, Duncan says. At best, only two-thirds of people with serious disorders got help for their problems. "All the countries have pretty bad under-treatment," he says. What's more, patients often see general practice doctors instead of mental health experts, a situation that can result in inadequate care.

The study was based on surveys between 1990 and 1999 of more than 23,000 people in Chile, Germany, the Canadian province of Ontario, Holland and the United States. Chile had the lowest prevalence of emotional problems, at 17 percent, while the United States had the highest, at 29 percent.

Germany had the highest rate of mood disorders, such as depression, but the United States led all countries with the proportion of people reporting anxiety (17 percent) and drug and alcohol abuse (11.5 percent).

Germany also had the highest rate of treatment for any problem, at 20 percent. Canada was lowest, at 7 percent, followed by the United States, at just under 11 percent. Although Canada has a national health plan, the study suggests it has relatively strict requirements for mental health.

When it came to treating serious conditions, the United States was the laggard, at just 37 percent compared with Germany's top rate of 67 percent.

In all five nations, people with serious mental health problems were three to five times more likely than those with mild or moderate trouble to say they received professional help in the year before the surveys.

Young, less-educated men were less likely than others to receive treatment for serious emotional trouble. Being a woman, having more education and being older predicted who was most likely to get treatment for disorders of any degree of severity.

The researchers included a category for "non-cases" -- people with emotional difficulties that didn't merit a diagnosis of a disorder. This might include someone bereft over the loss of a loved one but who doesn't have clinical depression. Rates of care for these people were low, but not negligible, in the countries surveyed, ranging from 3.4 percent in Canada to 14.1 percent in Germany. In the United States, 6.3 percent of non-cases received treatment.

Duncan, who is also on the faculty of Brown University Medical School in Rhode Island, says non-cases don't need the same array of mental-health services as people with more serious emotional trouble. When resources are short, their use of the health system can deprive others of more urgent care.

But Jennifer Bright, senior policy director at the National Mental Health Association, disagrees. "We would say that there is no such thing as a non-case. Anyone with an issue relating to mental health ought to be able to access services that help them, whether the problem is episodic or otherwise."

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On the Net:

National Mental Health Association

American Psychological Association

Brown University Medical School

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