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.

  • More than one in three persons who need treatment are not getting it. The leading barriers to receiving care include cost, lack of confidence that treatment helps, and lack of health insurance.
  • Eighty-one percent of those with a treatment history report taking a prescription medication. Forty-seven percent have used medication alone, 34% have used drugs and psychotherapy, and 19% have received psychotherapy only.
  • Consumers lack key information for selecting a therapist. Respondents seeking a therapist make their choices based on physicians’ recommendations, their health plans’ network, and geographic considerations. They have little opportunity to learn in advance about the therapist’s personal style or listening skills — the factors that they identify as being most associated with successful therapy.

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.

  • In the last two years, 27% of the general adult population have either seen a mental health professional for therapy or taken a prescription medication for a personal, emotional, or mental health problem.
  • Eighty percent of those who have received treatment have found it effective.
  • Eighty-five percent report that they are satisfied with treatment, and more than half (54%) are either very or extremely satisfied.
  • Women are disproportionately represented among those likely to have needed treatment (making up 58% of the total), as well as among those who have received it. Of the group that has received treatment, women make up 63%, vs. 37% for men.
  • Almost half of those surveyed (49%) know someone who has been in treatment, and almost two-thirds (61%) say they do not view the choice to receive therapy as a sign of character weakness.
  • Almost four out of five (79%) respondents believe that if a co-worker were in therapy it would make no difference in his or her ability to do the job. Seven percent of respondents say it would actually make the co-worker better able to do the job.
  • Forty percent of adults think that their parents would have benefited from therapy.

"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.

  • Thirty-seven percent of those who report having experienced distress sufficient enough to warrant treatment have not received it. This represents an estimated 24 million, which are just more than one in 10 people in the general U.S. adult population.
  • Cost and doubt about its efficacy are cited as the top reasons for not receiving treatment among those who have needed mental health treatment but not gotten it. Thirty-nine percent report that it is too expensive, 35% say that their problems have not been serious enough to warrant professional attention, 32% do not think treatment would help, and 26% cite concern about lack of insurance coverage.
  • Stigma inhibits some respondents from getting needed care: The fear that therapy would go on their "record" is mentioned by 22%, and the concern that friends or family could find out is mentioned by 19%. Such concerns are cited more often by men than by women.
  • More than half (52%) of the general adult population believes that it is somewhat or very difficult to access mental health treatment.
  • Thirty-seven percent of all insured respondents are unsure of whether their health insurance covers mental health care.

"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 most common factors cited in the choice of a mental health professional include recommendation from a doctor (28%), whether the therapist is part of the individual’s health plan network (26%), proximity to home or work (22%), and cost (17%).
  • In contrast, the factors ranked as most important in making therapy successful include the therapist’s listening skills (63%), the therapist’s personality (52%), the personal connection with the therapist (45%), the therapist’s being active in the session (38%), and the cost (38%).

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.

Sources

  • Psychology Today, P.O. Box 51844, Boulder, CO 80323-1844.
  • PacifiCare Behavioral Health, web: www.pbhi.com
  • PacifiCare Health Systems Inc., 5995 Plaza Drive, Cypress, CA 90630.
  • Harris Interactive, 135 Corporate Woods, Rochester, NY 14623-1457. Web: www.harrisinteractive.com