U.S. Lags in Mental Illness Treatment

Study:

America Has Highest Prevalence and Second to Lowest Treatment Rates Among 5 Countries

By Sid Kirchheimer

WebMD Medical News Reviewed By Brunilda Nazario, MD

on Wednesday, May 07, 2003

May 7, 2003 -- The Land of Plenty seems to live up to its name when it comes to mental illness. New research indicates that like many other nations, the U.S. has plenty of mentally ill citizens, but we also have plenty of problems in treating them.

According to the finding, the U.S. has the largest percentage of mentally ill citizens among five countries studied -- about 29% of its residents -- but scored worst in treating those with serious problems, caring for only one in three people who need it. These conclusions, published in the May/June issue of the journal Health Affairs, are based on surveys of more than 23,000 people in the U.S., Canada, Chile, Germany, and the Netherlands conducted through the 1990s by an international team of researchers.

Chile had the lowest overall prevalence of reported mental illness, at 17%, while Canada had the worst treatment rates for any emotional problem or mental illness, followed by the U.S. Germany had the best treatment rates for all problems as well as those with serious conditions, caring for two in three patients. The U.S. also led all nations in prevalence of drug and alcohol abuse and people with anxiety disorders, while Germany had the highest rates of depression and other mood disorders, the study shows.

All of the countries studied except the U.S. have universal health insurance that provides their citizens with low- or no-cost mental health and substance abuse treatment. In those other countries, public funds pay for the majority of treatment costs, and in Chile, Germany and the Netherlands, patients can choose whether to get treatment at public facilities or through private practitioners, paying for one-third or less of the costs out of pocket.

"In the U.S., the government offers some mental health care, but it has generally become inadequate and there's less and less funding for it," says David F. Duncan, DrPH, a psychological services consultant who served on President Clinton's Task Force on National Health Care Reform and is clinical associate professor of psychiatry at Brown University School of Medicine. "The systems are overburdened and there can be long waiting lists to get into what is usually fairly minimal care."

Duncan, who was not involved in the research but has consulted for several federal agencies, says he is not surprised by its findings. "The high prevalence of mental illness in the U.S. that was noted is consistent with other findings," he tells WebMD. "And I'm not surprised that most people here aren't getting treatment because it's expensive, and since we don't have national health insurance, many people can't afford it."

Most Americans depend on their employers to provide health insurance for their families, and the federal Agency for Healthcare Research and Quality reports that in 2000, about 60% of Americans were covered at their place of employment. But there are discrepancies: Among workers who earned at least $21 per hour, some 83% were covered, compared with only one in three of those making minimum wage.

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