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A new national snapshot of the state of mental health across America is, frankly, a little discouraging, especially when it comes to young people.
One startling finding from the annual report produced by the nonprofit Mental Health America: "[S]ixty-four percent of youth with depression do not receive any treatment."
In addition, the report found:
Even among those with severe depression, 63 percent do not receive any outpatient services. Only 22 percent of youth with severe depression receive any kind of consistent outpatient treatment (7-25+ visits in a year).
I asked one of our frequent contributors, child psychiatrist Dr. Eugene Beresin, executive director of the Massachusetts General Hospital Clay Center for Young Healthy Minds and professor of psychiatry at Harvard Medical School, for his thoughts on the report.
Here, lightly edited, is his response:
First, I am not surprised. There are a number of issues not emphasized by this summary:
1. There is a huge shortage of child and adolescent psychiatrists in the U.S. Currently there are about about 7,000.
So while many parents seek help, the access to care is severely limited. Primary care pediatricians are inadequately trained in psychiatry and this has been addressed by the American Academy of Pediatrics. Their graduate training requires only two months in developmental behavioral pediatrics and few have any significant training in psychiatry. They are desperate to make referrals and often are at a loss to find qualified clinicians. Some states such as Massachusetts and New York have statewide efforts to assist them through consultation and education in psychiatry, but this only scratches the surface.
2. The college situation is analogous. Up to 50% of students have psychiatric problems, and in large universities there is only about one certified mental health professionals to deal with 3,000 students. Only about 25% of students with problems seek help.
3. While there was legislation for parity in mental health services, this has been woefully inadequate. There is strong data that combining medication management with psychotherapy has better outcomes than either treatment alone for some serious psychiatric disorders. However, insurance covers unlimited visits for medication management ALONE and these visits tend to be 15-30 minutes. Psychotherapy visits that typically allow for 24 visits a year could include both. But this limits combined treatment to 24 visits a year maximum for most insurance policies. That is typically insufficient for many treatments.
4. Reimbursements through insurance for mental health treatment are very low compared with other care. Thus psychiatry in the outpatient sector is a huge financial drain on health care systems. And there is a great shortage of inpatient beds for youth and for very short lengths of stay. Often pediatric psychiatric facilities are overwhelmed with youth and families that are stuck without places to go.
5. Treatment for psychiatric disorders is as good as treatment for most medical disorders. However, the stigma of having a psychiatric disorder stops many people from seeking treatment. They are often too ashamed to seek help; or many believe that psychiatric disorders are untreatable, and thus they do not seek help. Other reasons for not seeking help is the fear that this will be on one's permanent medical record — another aspect of the shame and embarrassment of having a psychiatric disorder.
But the data show that the lifetime prevalence (possibility) of developing a psychiatric disorder is about 24%. Thus one of the most common kinds of disorders in medical practice goes largely untreated. And it should be noted that most psychiatric disorders begin in youth (children through late adolescence and young adulthood). One would hardly avoid going to a doctor for asthma, migraines or other common illnesses and many who suffer from anxiety, depression, PTSD and other common problems do not seek help.
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