The prevalence and correlates of untreated serious mental illness.
OBJECTIVE
To identify the number of people in the United States with untreated serious mental illness (SMI) and the reasons for their lack of treatment.


METHODS
The National Comorbidity Survey; cross-sectional, nationally representative household survey.


METHODS
An operationalization of the SMI definition set forth in the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act identified individuals with SMI in the 12 months prior to the interview. The presence of SMI then was related to the use of mental health services in the past 12 months.


RESULTS
Of the 6.2 percent of respondents who had SMI in the year prior to interview, fewer than 40 percent received stable treatment. Young adults and those living in nonrural areas were more likely to have unmet needs for treatment. The majority of those who received no treatment felt that they did not have an emotional problem requiring treatment. Among those who did recognize this need, 52 percent reported situational barriers, 46 percent reported financial barriers, and 45 percent reported perceived lack of effectiveness as reasons for not seeking treatment. The most commonly reported reason both for failing to seek treatment (72 percent) and for treatment dropout (58 percent) was wanting to solve the problem on their own.


CONCLUSIONS
Although changes in the financing of services are important, they are unlikely by themselves to eradicate unmet need for treatment of SMI. Efforts to increase both self-recognition of need for treatment and the patient centeredness of care also are needed.
Kessler
R C
RC
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Berglund
P A
PA
Bruce
M L
ML
Koch
J R
JR
Laska
E M
EM
Leaf
P J
PJ
Manderscheid
R W
RW
Rosenheck
R A
RA
Walters
E E
EE
Wang
P S
PS
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D018802:Patient-Centered Care; D015995:Prevalence; D011787:Quality of Health Care; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology