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Mental health treatment found lacking

Judith Graham Chicago Tribune

CHICAGO – Only a third of Americans seeking help for a mental disorder receive treatment that meets professional standards, suggesting many people in distress aren’t getting the help they badly need, according to the first extensive national survey in a decade on mental illness in the United States.

Four studies published this week in Archives of General Psychiatry indicate emotional disturbances are strikingly common, with a quarter of all Americans suffering from at least one mental disorder in a given year.

Mental illness also starts early: Half of all cases were found to have surfaced before age 14.

The picture emerging from the reports is of a mental health system that often does too little too late to treat disorders and one that supplies many therapies not demonstrated to be effective.

Among the problems are inadequately trained service providers, scarce data about what works and lack of accountability for outcomes, said the authors from Harvard University and the University of Michigan.

“I don’t think the nation would tolerate these kind of results for cancer or heart disease, yet (mental) conditions are just as fatal – if not more so – than physical illnesses,” said Dr. Thomas Insel, director of the National Institute of Mental Health.

The researchers surveyed 9,282 Americans age 18 and over.

Researchers said patients also bear some responsibility as they often do not comply with treatment. And many rely on unproven alternative therapies.

A similar survey researchers published in 1994 attracted attention when it reported that 48 percent of Americans have experienced an emotional disorder at some point in their lives. Al-though critics said that number was impossibly high, the new survey resulted in much the same figure: 46.4 percent.

More than a fourth of the population – 26.4 percent – told surveyors they had suffered from a clinically significant mental disorder within the last year. That’s similar to data from a decade ago.

The Harvard and Michigan researchers deemed only one-third of the mental treatments received to be minimally adequate, implying most treatments might have little beneficial effect.

Most growth in treatment was attributable to primary-care doctors who don’t receive much training in mental health and whose patients may be less motivated to follow through on treatment. Care in those settings – usually prescriptions for psychoactive drugs – met standards less than 13 percent of the time, the authors found.

They also said a third of all mental health visits were for therapies such as massage or intensive meditation, whose benefits have not been established.

The researchers defined “adequate treatment” as receiving appropriate medication if warranted, taking the drug for at least two months and seeing a doctor four or more times to monitor the effect. If counseling or therapy was the treatment of choice, at least eight visits were considered adequate.

But some experts questioned the researchers’ conclusions, citing a lack of consensus in the mental health field about what constitutes acceptable care.

“I couldn’t tell you what ‘minimally adequate’ care means, and I challenge anyone else to do so,” said Leonard Bickman, a professor of psychology and psychiatry at Vanderbilt University.

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