Read Part 3 to know about Comorbidity, Life Expectancy, & Suicide.

Access to Treatment

Mental health problems and illnesses are the leading cause of disabilities. (WHO) Yet, according to a 2005 report, only 6% of health care dollars are directed towards mental health care. Of those health care dollars spent, the majority (80%) are in human resources. In other words, there is a high workforce attrition in the mental health field. There are three areas that play a critical role in accessing mental health care: 1) Financial Resources; 2) Stigmatization; 3) Availability of competent mental health care providers.

a) Financial Resources

Historically, financial resources directed towards mental health have not matched the dollars spent on physical health care. As recently as 1997, states spent 30% less on mental health than they did in 1955 after adjusting for inflation and population growth. There are multiple reasons for this, but one major cause has been the stigma associated with mental illness. This stigma has dampened any public discussion of mental health needs. However, over the last two or so decades, largely as a result of the gathering data showing the magnitude and the cost of a mental health problem, there has been a considerable shift in the attitude that mental health problems and illnesses need to be urgently addressed. As a result, there has been an increase in funds available for mental health care from Federal programs, more localized programs (state and provincial), and many private and public health insurance plans. Even so, the general conclusion is that mental health care is underfunded and the funds that are available are not managed as effectively as they could be. As a result, those who need support for their mental health needs are often limited in their ability to obtain the quality care that they need.

Any solution to successfully addressing the mental health needs in North America will need to take into account these resource limitations and the likelihood that there will not be any major increase in those resources on the government level anytime soon. This means that a more grassroots (with government support and guidance) approach is needed with the development of more efficient, effective strategies that consume less time.

b) Stigmatization

Since rumours of having been treated for depression threatened to derail Michael Dukakis’ 1989 bid for president, considerable progress has been made in eliminating the stigma of having a mental illness or mental health problem. Unfortunately, stigmatization is still a factor that needs consideration when it comes to mental health problems and illnesses.

The stigmatization associated with mental health problems and illnesses can hamper having the social support mechanisms necessary for recovery or living a normal life. According to the 8^th Annual National Report Card on Health Care (2008), 72% of people would tell a friend or co-worker if a family member had cancer, only 50% would do the same when it comes to a mental illness. One in

four report being fearful of someone with a serious mental illness. Slightly less than half (46%) use “mental illness” as an excuse for bad behavior, while 55% indicate they wouldn’t marry someone with mental illness and at least 58% would not hire a physician, financial advisor, lawyer, or child care worker with a mental illness.

For many people, having a mental health problem or illness is felt to be shameful and because of the stigma, many people do not seek help. Although the focus of stigmatization’s impact centers on serious mental illness e.g. schizophrenia, stigmatization plays a role in whether people with mental health problems, rather than illness, seek support as well. For some, seeking psychotherapeutic support might be perceived as a weakness or incompetence in dealing with “normal” life issues. As a result, they only obtain professional support for emotional or relationship issues when they are forced to i.e. to avoid divorce, losing their employment, or incarceration. By this time, the problem will have likely escalated to a point that it poses a greater challenge to address than if a more preventive approach had been taken. It is believed that eliminating the stigma associated with mental health problems and illnesses will result in people becoming more willing to taking a preventive, proactive approach to their mental health.

c)Availability of competent mental health care providers

Only about 10% of those needing care receive mental health treatment in developing nations. Although conditions are generally much better in the developed, wealthy countries, only about 50% of those needing support are able to obtain mental health care.

One reason for this is the lack of local mental health care providers or agencies. Rural areas and tribal lands tend to have less access to health care providers in general. Finding a mental health care provider in these areas poses an even greater challenge.

A second reason that so many people are unable to get appropriate and effective health care is economics. Although the poor have programs such as Medicare and Medicaid, they typically don’t have access to the same level of support as do those who are more financially well off. The middle class may have access to better quality support, but they may not have health plans that cover mental health. The fees that accompany mental health care may be too much for many budgets today.

A final reason affecting the availability of competent mental health care providers is the mental health workforce itself. As mentioned, around 80% of all mental health dollars is spent by human resources to find replacements for vacated jobs. On top of this high attrition, many therapists, for various reasons, do not keep up with the latest research findings. It is estimated that it takes at least ten years for any advances in psychotherapy to find their way into the clinical setting.

Read the next blog to know about the mental health problems and illnesses have a cost.