It’s probably no big surprise that many people with mental health issues don’t readily seek treatment for their concerns. But how widespread is this pattern?
A 2004 report by the World Health Organization reviewed rates of psychiatric treatment usage across 37 research studies. The findings are unbelievable. Between 30 and 80 percent of people with mental health concerns never receive treatment.
From this analysis, the average non-treatment rates for specific disorders were: schizophrenia (32%), bipolar disorder (50%), panic disorder (55%), major depression (56%), generalized anxiety disorder (57%) obsessive-compulsive disorder (59%), and alcohol dependence (78%). It’s also acknowledged that these rates are probably lowerthan the actual number of people failing to receive treatment.
Let those numbers sink in for just a minute. They show that more often than not, the majority of people who are dealing with real mental health issues don’t ever get the appropriate care they need.
1) Fear and shame
One of the most common reasons for not seeking help is fear and shame. People recognize the negative stigma and discrimination associated with having a mental illness and don’t want to be labeled “mentally ill” or “crazy.” They may also have concerns about how such a label could negatively impact their career, education, or other life goals.
2) Lack of insight
If someone has clear signs of a mental illness but says “there’s nothing wrong with me,” “I’m not sick,” or “I don’t need any help,” this signals a severe lack of insight. This is also known as anosognosia (uh-no-sog-NOH-zee-uh), seen in 50% or more of persons with schizophrenia or other severe mental illnesses. If someone truly believes they aren’t sick, they feel no need to seek or accept treatment.
3) Limited awareness
A person may acknowledge some mental health concerns but can lack full awareness of their significance or really don’t understand they have an actual illness. They may dismiss or minimize their issues and say “everyone gets stressed out” or “my problems aren’t that bad” or “you’re making more out of this than you need to.”
4) Feelings of inadequacy
Many people believe they are inadequate or a failure if they have to admit something is “wrong” with their mental health. Further, they believe they “should be able to handle things” on their own without assistance and that they must be weak or inferior to have to ask for help.
It’s difficult to consider revealing personal details to a doctor or counselor. Many express concern about “telling a stranger” about their problems. Additionally, they worry that their personal information won’t be kept confidential.
Some people have become demoralized by their mental health issues and believe “nothing will help me” or “I’ll never get better.” These beliefs can be due to depression or hopelessness, and can be substantial roadblocks to seeking help.
Even if someone is interested in getting mental health treatment, they may not know how to find appropriate professional care. In some underserved areas, there may be few or no mental health professionals, particularly those who provide treatment for more complex issues.
8) Practical barriers
Other common barriers to mental health care include inability to pay for treatment, due to financial hardship or lack of health insurance. Not having reliable transportation, child care issues and appointments for treatment that conflict with work or school schedules can also prevent someone from engaging in treatment.
Addressing the problem
Any one of these factors which delay or prevent appropriate care can be very difficult to overcome. To further complicate matters, several of these issues can often be in play simultaneously. These barriers are often even more pronounced among ethnic minority groups, older adults and individuals with less money or education.
Just as the issues are complex, solutions aren’t easy to find. Addressing practical barriers may be possible, by helping to arrange transportation, assisting with child care, or negotiating with employers to allow time away from work for mental health appointments.
The recent expansion in the US of mental health insurance benefits has opened up new care options for many people who were previously uninsured and who couldn’t afford to pay out of pocket for their treatment.
Availability of services can be a difficult issue to address, particularly in rural areas with few mental health clinicians. The increase of nurse practitioners as prescribers and programs which pay off clinicians’ student loans in exchange for their work in underserved areas have increased the number of trained providers in some regions.
The pronounced lack of insight seen in more severe mental illnesses is extremely difficult to change. One suggested approach to help improve insight is the “LEAP”(Listen, Empathize, Agree, Partner) model. After listening and empathizing with the person, mutually agreed upon goals can be identified and a partnership can be formed to help the person begin to achieve their goals.
Finally, many of the more “hidden” factors (fear, shame, inadequacy, limited awareness, and hopelessness) are challenging, because the person may function fairly well on the surface and can generally conceal their mental health concerns. If they begin to talk about these issues, they can then be encouraged to seek care to relieve their distress. Ongoing efforts to reduce stigma and discrimination are essential to send the clear message that it’s ok to talk openly about mental health issues and to ask for help.
Currently, legislation is being introduced in the US Congress that strives to address many of these issues, by improving access to care, promoting effective treatments and increasing services for underserved populations. While many details need to be debated and resolved before passing this bill, it could potentially benefit many individuals with mental illness and those who care deeply about their welfare.