Study Documents Under Treatment
of Mental Health Needs

Although under treatment of mental health needs in this country should come as no surprise to you, it does help to have some actual data to back up the depressing reality that we need more quality mental health care in this country even as managed care seeks to drive down and out those professionals who can help people the most with their problems in living. A study published in the January issue of Archives of General Psychiatry provides confirmation that mental health problems in this country are infrequently diagnosed and even less frequently treated appropriately. A study commissioned by the University of California at Los Angeles-RAND Research Center on Managed Care for Psychiatric Disorders and conducted by Alexander Young and associates found that fewer than one-third of adults with diagnosable depressive illness or anxiety disorder received proper treatment. These results held across all demographic groups but some groups fared even worse. African Americans, the elderly and the young were even less likely to receive appropriate treatment. Interestingly, the survey found that income level and insurance coverage were not related to appropriateness of care. (See box insert for the results.)

New York Times medical writer Rosie Mestel reported these results in a recent article and it is perhaps unsurprising that the thrust of her article focused on the fact that people, especially in the underrepresented groups, do not typically seek out treatment for these problems. “You can probably lay a bit of blame on everybody,” said Dr. Daniel Ford, associate professor of medicine, health policy and management at Johns Hopkins University School of Medicine. Primary care physicians got hit for failure to diagnose properly. The article ended with a description of the efforts of those great protectors of mental health, PacifiCare and Kaiser Permanente to better identify and treat people for these illnesses. There was one throwaway line that “Not everyone has good, affordable access to mental health care, even if they have health insurance.” It is nice to observe that the destruction of the mental health care system in this country thanks to the rapaciousness of managed care received at least a passing glance from the magisterial Times.

For purposes of the study, the definition of appropriate care was exceedingly generous, with the criteria being two months of medication or four sessions of psychological counseling!  The Times article provided an apt comment on this criteria from Herbert Schulberg, professor of psychology and psychiatry at Cornell: “To find that so few people were being treated for major depression--even for only two months--is rather an appalling statistic.” Perhaps we should be grateful that psychotherapy was even listed as an appropriate treatment at all.

Now it may come as a surprise that the RAND Research Center on Managed Care for Psychiatric Disorders even exists let alone sponsors studies that give some heart to the struggle to keep quality mental health care on the national agenda.  But for all the blinkered view of mental health needs and care embedded in the study, its findings should be seen as providing Coalition members more concrete data in our efforts to create a better mental health care system in this country

Reference

Young, Alexander S., Klap, Ruth; Sherbourne, Cathy D.; Wells, Kenneth B. (2001) The quality of care for depressive and anxiety disorders in the United States  Archives of General Psychiatry 58 (55-61).

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