The Unmet Need for Mental Health Services
According to the latest survey, every one in five Americans suffer from mental illness every year. This, however, is based on the data collected from the clinically diagnosed cases. When we take a look at the undiagnosed cases as well, the results come out that about every second individual requires mental healthcare services in America.
Studies show an increased disparity in mental healthcare services in terms of quality of care, availability, and service utilization across different races, cultures, ethnicities, age groups and economic strata in society. Latino kids have higher rates of unmet needs than white children, consequently leading to greater suicidal thoughts/attempts, depression, anxiety, and rates of dropping out of high school than white children. Moreover, uninsured individuals also have higher rates of unmet requirements as compared to the publicly insured individuals. Insurance schemes provide a significant safety net. The requirements of mental healthcare are not adequately met for the geriatric population as well even though there are many health and social services available. This is due to the fact that the emotional or physical impairments hinder them to avail these services. It is found that the unmet mental health need is related to nonmetropolitan area residences, geriatric age groups, lower socioeconomic classes, the uninsured, mildly severe to severe stages of the disease, not having a support system, a family history of unmet mental healthcare needs, a history of emotional, developmental, or behavioral disability, and so on.
Diagnosing a mental illness clinically requires the patient to satisfy the clinical symptomatology of the disease. However, most of these illnesses appear in the form of symptoms at a much-advanced stage. Mental illnesses are generally chronic and slowly progressing. Also, there are frequent overlaps between more than one disease. As a result, often the symptoms of a patient’s condition do not fit any one mental illness and therefore, the needs of availing the mental healthcare by such patients remain unmet. In other cases, if patients receive the mental healthcare services, they get discharged or are lost to follow-up as soon as their conditions do not fit the criteria of the disease, even if there are a few symptoms still present. This does not necessarily mean the patient has the disease and is not being treated for it, but that the remaining symptoms of the disease in the patient are not enough to make him qualify for the disease. The tip of the iceberg may not necessarily show the size of the iceberg (in this case, the extent of the disease).
Unmet needs for mental healthcare can be measured by using various scales like the Camberwell Assessment of Need (CAN), Verona Service Satisfaction Scale (VSSS), etc. The CAN scale is shown to be reliable and valid, consisting of 22 individual domains like food, daily activities, living conditions, physical health, psychotic symptoms, etc. Although these scales are based on user ratings, they give an idea of what the patient still feels about his condition, since ultimately one of the goals to providing healthcare services is to provide a more satisfying state of health (physical/mental).
For unmet needs of mental healthcare, intensive care should comprise of the assessment of a wider range of needs than hospital care, therefore leading to more needs being met. This way there can be an overall decline in the number of unmet needs for mental healthcare. Family counselling, increasing insurance cover, education to remove the stigma attached with obtaining mental healthcare services, cheaper treatments, more follow-up, increasing access to mental healthcare services in remote areas, loosening the diagnosis criteria if the patient shows symptoms, etc. can go a long way in declining the number of unmet needs for mental healthcare in the society.
“Unmet need for mental health services” is not only the number of individuals with mental health disorder not receiving mental health services, but also those who are not completely cured and remain undiagnosed for any of the reasons explained above. It is highly imperative to take steps to intervene in this direction for reducing the unmet needs of mental healthcare around the world.
References:
Black, Betty Smith, Peter Rabins, Pearl German et al. 1997. “Need and Unmet Need for Mental Health Care Among Elderly Public Housing Residents”. The Gerontologist, 37:6, 717-728.
California Mental Health Planning Council, chapter 3, “Unmet need for public mental health services”.
Kataoka, Sheryl, Lily Zhang and Kenneth Wells, 2002. “Unmet need for mental health care among U.S. children: Variation by Ethnicity and Insurance Status”. The American Journal of Psychiatry, 159 (Issue 9), 1548-1555.
Leese, Morven, Sonia Johnson et al. 1998. “User Perspective on Needs and Satisfaction with Mental Health Services”. British Journal of Psychiatry (1998), 173, 409-415.
