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Study: More people receive mental health treatment
Reduced stigma leads more to seek help
More than one in four U.S. adults has received treatment for a mental health problem in the past two years, via talk therapy, medication, or a combination of the two, according to a new Harris Interactive poll, "Therapy in America 2004." Harris Interactive is a national research and polling firm best known for conducting the Harris Poll, which is a survey of public opinion on a variety of topics.
The study was conducted in March using a nationwide phone survey of 501 adults, with a follow-up on-line survey of 1,731 people known to have needed or received treatment. The national magazine, Psychology Today, its Internet-based companion Therapy Directory, and Los Angeles-based PacifiCare Behavioral Health, a national behavioral health care organization, sponsored the survey. Key findings include:
• Mental health treatment has become an important part of American life. Twenty-seven percent of adults, or an estimated 59 million people, received treatment in the past two years. Of these, the large majority report high levels of efficacy and satisfaction, regardless of the type of treatment received.
The survey design weighted the responses of participants in the survey to extrapolate the results received to the U.S. population as a whole.
The telephone portion of this project was conducted within the United States between Feb. 16 and March 5, 2004, among a nationwide cross-section of 501 adults. Figures for age, sex, race, education, region, household income, number of adults, and number of voice/telephone lines in the household were weighted where necessary to bring the total population of all adults in line with their actual proportions in the population.
According to Harris Interactive, it is expected that 95 % of surveys with samples of this size would produce results that were within + 4 percentage points of what they would be if the entire adult population had been polled using the same methods.
The on-line portion of this survey was conducted within the United States between Feb. 27 and March 1, 2004, among a nationwide cross-section of 1,731 adults who qualified for the survey on the basis of having needed and/or received mental health treatment within the previous two years, according to the definitions of "need" and "treatment" used in the survey.
Figures for age, sex, race, education, region, and household income were weighted where necessary to bring them into line with their actual proportions among those in the general population meeting these same mental health criteria.
"Propensity score" weighting was also used to adjust for respondents’ propensity to be on-line. With probability samples of this size, one could say with 95% certainty, that the results have a statistical precision of + 3 percentage points of what they would be if the entire adult population had been polled with complete accuracy. The on-line sample is not a probability sample.
The term "need for treatment" was determined based on responses to the Life Status Questionnaire, an assessment tool used and clinically validated by PacifiCare Behavioral Health. The respondents’ self-perceived need for mental health treatment was also considered, as well as the fact that they had spoken to a primary-care doctor about this at some point within the past two years.
"Therapy" was defined as follows: "When we use the word therapy,’ we mean talking to a mental-health professional (such as a psychiatrist, psychologist, social worker, or marriage-and-family therapist) on a regular basis about problems or things that are bothering you. This can be either alone, on a one-on-one basis, or in a group setting."
Treatment widely accepted
According to the survey results, if you are not in treatment, chances are you’re sitting next to someone who is. From co-workers to family members, a substantial number of Americans have friends or loved ones who have received talk therapy or medication. And, respondents also believe that many of their closest associates and relatives would benefit from treatment.
"We’ve gained extraordinary insight into a part of life that usually takes place behind closed doors," said Jo Colman, publisher of Psychology Today and the Therapy Directory. "We did not expect to find so many people had taken advantage of the treatment options now available to them, or the extent to which the stigma surrounding the subject appears to have subsided."
Many needing treatment still don’t get it
While the majority of Americans are familiar with mental health treatment — either through their own experience or that of a family member or friend — a sizable number of those who appear to have needed treatment have not received care. These people are doubtful about the efficacy of treatment, stymied by cost, or concerned about stigma, the survey results indicated.
"These survey results confirm what we’ve always believed and validate the direction in which we’re moving," said Jerry Vaccaro, MD, president and chief executive officer of PacifiCare Behavioral Health, a subsidiary of PacifiCare Health Systems. "We’re in the process of developing new programs that identify and reach out to these people so they can get the help they need."
Medication preferred over talk therapy
The fact that most of those receiving treatment are being treated with medication alone is one of the survey’s more controversial findings.
For those with a treatment history, 81% percent, or an estimated 48 million people, report taking or having taken a prescription medication for a personal, emotional, or mental health problem in the past two years. In contrast, only 53% report undergoing psychotherapy.
Yet, only 25% of American adults who have taken prescription drugs for a mental health problem did not report the level of distress typically associated with those in need for therapy. One-quarter of those taking only medication have received a recommendation from a doctor that they receive talk therapy as well, but have not done so. And older Americans (ages 50 and older) are significantly more likely to receive medication alone than are those between the ages of 18 and 49.
"Clearly, medication has made it possible for many more people to seek and receive treatment, especially men who historically might have shied away from therapy," Vaccaro says. "We know, however, that not all medications work effectively on all people. Talk therapy, particularly goal-focused cognitive therapy, has been shown to be as effective alone or in concert with medication for many patients. Our role as a consumer health organization is to help consumers get the right treatment at the right time."
Survey respondents reported several challenges in accessing information that would enable them to choose a therapist able to meet their needs. This may play a role in the large number of people using medication without therapy, he speculates.
The pragmatic factors that people consider when choosing a therapist, including geographic proximity and cost, fail to address a crucial element of treatment: a good therapist-client match.
There is a clear discrepancy between the criteria people use to select their practitioner and the criteria they identify as conducive to successful therapy, the survey indicated. For example:
The publishers of Psychology Today have attempted to improve access to information about therapists via their on-line Therapy Directory (which can be found at www.psychologytoday.com), Colman states. The directory provides consumers with a flexible way to search a directory of 20,000 licensed professionals. Therapists identify their areas of expertise, interests, training, and cost per session. Many include personal introductions and photos.