Two Major Problems Facing Mental Health Treatment

Mental health issues receive an increasing amount of attention from the media these days. Whether it’s anxiety levels in college students, concerns about the opioid epidemic, rising rates of autism diagnoses, or the potential to overdiagnose ADHD, there’s no doubt that public awareness of mental health is growing. However, despite this increased awareness, all mental health issues face a common challenge: Individuals in need of treatment often struggle to receive timely treatment and effective treatment.

Most individuals who need mental health services either do not or cannot access appropriate treatment.¹ The reasons for this are multifaceted and complex. Aside from longstanding challenges—such as the difficulty of acknowledging that you may be struggling with mental illness and the potential stigma associated with seeking mental health treatment—there simply are not enough trained providers to meet the demands of the population. While there are multiple ways for someone to address their behavioral health concerns (e.g., self-help books, online resources, spiritual counsel, peer support), the primary modality by which mental health issues are treated is through weekly, individual therapy services with a trained service provider. Time is finite, and this model significantly limits how many individuals in need can receive therapeutic services. Furthermore, identifying a potential provider who 1) is in your area, 2) has availability for new clients, 3) has an open therapy time that you can attend, 4) either takes your insurance or has a fee schedule you can afford, and 5) has expertise in the area of mental health for which you are seeking services is unfortunately a tall order.

When individuals are able to receive treatment, the type and quality of the treatment they receive can vary quite widely. The past few decades have seen a shift to a greater emphasis on encouraging providers to use evidence-based practices in mental health, which means that treatments should have evidence from research studies that that they lead to improved outcomes. However, most research studies examining the type of treatments delivered in routine clinical settings suggest that many providers do not use evidence-based practices. This is often referred to as a “research to practice gap” in mental health. Again, the reasons for this gap are quite complex - the type of treatment any given individual receives is influenced by many factors, including individual choices and preferences, organizational values and resources, systems/policy level factors, and much more.^2,3 Complicating this challenge further, there is widespread disagreement about what constitutes appropriate “evidence” for whether or not a particular type of mental health treatment works or is appropriate for certain individuals.

The goal of this blog is to delve into these issues and more surrounding the challenges of accessing timely and effective mental health treatment. Exciting work is occurring in this space aimed at improving the reach of high-quality mental health interventions. This blog will explore and highlight new service models and strategies that are being developed to address the mental health needs of the population and improve the quality of mental health care that is delivered across clinical settings. The ideas I will discuss will draw from the numerous domains that influence mental health care, including individual, organizational, and political factors.