Barriers to Mental Health Treatment Access in the U.S.

Introduction

Mental health problems are common, and many people experience isolated bouts of depression or anxiety from time to time. These problems typically dissipate and never create long-term difficulties. For some people, however, mental health problems can cause harmful, life-altering consequences if left untreated. Unfortunately, there are a large number of mentally ill people in the United States who never receive professional treatment for their condition in their entire lifetimes. Some authorities argue that as many as nine out of ten people who need mental health treatment do not receive these services as a result of a wide range of factors that obstruct access — factors that are particularly prevalent among minorities. To gain current insights into these obstacles, this paper reviews the relevant literature and summarizes key research findings in the conclusion.

The United States has a mixed mental health care delivery system comprised of a partnership between the public and private sectors that draws on evidence-based practices to treat the full range of mental health conditions. Currently, however, access to mental health services is described by authorities as dismal at best and a "national failure" at worst. Conyne emphasizes that "only 10% of children and adults who need mental health services receive them from mental health specialists or general medical providers in any given year. This disconnect between the need for mental health services and their delivery is a national failure" (2004, p. 11).

Background and Overview

One of the more troubling aspects of this major disconnect between what is needed and what is being delivered is how inequitable access is for whites compared to minorities. Conyne adds that "even worse, access to mental health services is more limited for ethnic and racial minority members. In fact, striking disparities exist between access to mental health services for whites and for minorities" (2004, p. 11).

Four major areas of inequity have been identified with respect to whites and minorities in the provision of mental health services in the United States:

It is clear that there are profound inequities in the provision of mental health care services to ethnic and racial minority members. Conyne (2004) suggests that while increased access is an across-the-board challenge, some initial steps must be taken to facilitate long-term change. As Conyne writes, "although all of these disparities are alarming, the first two are most immediately pertinent with regard to prevention. The high need for mental health service is not matched with its provision or with access to it" (2004, p. 11).

Obstacles to Access to Mental Health Services

Although the specific factors that obstruct access to mental health services vary from individual to individual, a number of general factors have been identified, including the following:

Taken together, these factors — individually or in combination — can adversely affect access to mental health services, particularly the multidisciplinary individualized treatments that many people require. Conyne concludes that "the overall supply of mental health professionals is not sufficient to meet the overall demand, especially if mental health services are delivered remedially to one individual at a time" (2004, p. 11). These observations are especially relevant with respect to the racial, cross-cultural, and age-specific mental health treatments that are required.

While there has been growing interest in identifying efficacious treatments for mental health disorders among children and adolescents, there has not been a corresponding increase in research directed at the specific obstacles to access that exist among young people. According to Ollendick and March (2004), "recent advances in our ability to identify and treat childhood anxiety disorders effectively, as well as our understanding of the morbidity associated with untreated anxiety disorders, highlight the importance of improving children's access to treatment" (2004, p. 530).

Barriers to mental health services can have profound and long-term consequences for young people. Brindis, Morreale, and English (2003) emphasize that "high rates of suicide, depression, and substance abuse in adolescents suggest that many teens need access to mental health and substance-abuse services" (p. 116). Given this profound need, it is troubling that so many obstacles continue to prevent young people from receiving the help they need. Brindis and colleagues point out that "although the possibility of broad coverage for mental health and substance-abuse services exists, numerous limitations exist, such as high cost sharing and restrictions on numbers of outpatient visits per year, numbers of inpatient days permitted, and the types of providers who can deliver services and be reimbursed" (2003, p. 117).

While these obstacles are typically applicable to younger children and adults, their implications for adolescents are even more severe. As Brindis et al. stress, these barriers "are likely to have greater significance for adolescents: during this developmental period, many behaviors and illnesses that require mental health services — such as drug use, depression, and eating disorders — have their onset" (2003, p. 117).

Conclusion

The research showed that a wide range of efficacious treatments exist for mental health disorders — treatments that can help people regain control over their lives and avoid the long-term adverse consequences of untreated mental illness. Unfortunately, the research also showed that only a small fraction of those with mental health disorders receive treatment because a broad array of obstacles inhibits or prevents access to timely and effective interventions. These obstacles include the high cost of mental health care, the frequent fragmentation of services, and insurance that is nonexistent or inadequate for the services needed. Additional obstacles include the geographic unavailability of services and powerful cross-cultural factors that can adversely affect access to care.