U.S. Mental Health Spending Rises, But Many Still Left Out
TUESDAY, May 5 -- Mental health spending in the United States increased 65 percent in the past decade, and many more Americans are using mental health services, but there's still a big difference between access to care and quality of mental health care received, new research shows.
In a special edition of the May/June issue of Health Affairs focusing on mental health care in the United States, one study found that about half of Americans suffering from mental illness in a given year don't receive treatment, and another 25 percent receive treatment that's not consistent with evidence-based guidelines.
Some patients may receive inappropriate treatments, simply because doctors lack the evidence to make an informed decision about appropriate care, noted Philip Wang, acting deputy director of the National Institute of Mental Health, and colleagues.
Another study suggested that even when doctors have information about best practices, patients don't always receive the correct treatments. That's because financial incentives, regulations, the quality of the mental health workforce, and drug company marketing strategies have a major impact on doctors' treatment decisions, said Marcela Horvitz-Lennon, of the Western Psychiatric Institute and Clinic in Pittsburgh, and colleagues.
They said underuse of effective treatments and overuse of ineffective treatments undermine the quality of care and lead to poor patient outcomes. For people with severe mental illness, that can result in increasing isolation, repeated hospitalizations, inability to get or hold a job, and even suicide.
Another study found that the number of seniors receiving psychotropic drugs to treat Alzheimer's and other mental health disorders doubled between 1996 and 2006, and the number of adults and children using the drugs increased by 73 percent and 50 percent, respectively.
The use of psychotropic drugs has increased, because primary-care doctors have become more familiar with these types of drugs and lower-cost drugs have become more available, said Sherry Glied, chair of health policy and management at the Mailman School of Public Health at Columbia University, and colleague Richard Frank.
The researchers also found that access to mental health care has improved for many Americans, but challenges persist for many groups of people. Between 1996 and 2006, treatment declined for elderly people with mental limitations that make it difficult for them to do daily living tasks such as dressing, eating and bathing without assistance.
Glied and Frank also found that more people with serious mental illnesses are being imprisoned or incarcerated. About 7 percent of people with persistent mental illnesses are put in jail or prison every year.
Another study found that many members of the military and veterans get inadequate treatment or no care at all for post-traumatic stress disorder (PTSD) and depression. The Rand Corp. researchers said more needs to be done to better prepare community health providers to help veterans with mental health problems when they return home.
In addition, the Department of Defense needs to reduce institutional and cultural barriers to seeking mental health care, especially for active-duty military personnel.
A study by Robert Drake, a psychiatry professor at Dartmouth Medical School, and colleagues concluded that a national program to help mentally ill people on Social Security disability programs find jobs could save the federal government $368 million a year.
The researchers noted that about 27 percent of people receiving Social Security Disability Insurance benefits are mentally ill, and that up to 70 percent of people with mental illnesses want to work.
"Giving people with mental disabilities the power to build financial security will help improve their quality of life significantly by encouraging self-sufficiency and building self-esteem, which can ultimately help move their treatment forward as well," Drake said.
Posted: May 2009
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