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Understanding Gaps in Mental Health Treatment Amidst National Crisis

Exacerbated by the COVID-19 pandemic, disparities in mental health treatment persist domestically and globally.

Veronica Salib
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Published: 28 Aug 2023

Across the United States, the healthcare system remains imperfect. One of the most jarring chasms in healthcare is the gaps in mental health treatment and services.

According to a March 2022 report from the United States Senate Committee on Finance, approximately 14.2 million people in the US had severe mental illness, which impaired function, in 2020. Annually, 17% of young people have a major depressive episode.

Roughly 40 million Americans over 12 live with a substance use disorder, including 2.7 million with opioid use disorder. The report also covered suicide rates in the US, noting that it is the tenth leading cause of death.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), mental illness is not treated as efficiently as it should be despite being very common. An estimated 20% of adults in America have a mental illness, including bipolar disorder, major depression, schizophrenia, anxiety disorders, post-traumatic stress disorder (PTSD), and more.

Although identifying the correct mental health treatment can be a long process, evidence-based research has shown that multiple mental health conditions can be effectively managed with medication and other health resources.

Before the COVID-19 pandemic, mental healthcare in the US was short of perfect. However, with the excessive burden that the pandemic has placed on the healthcare system, previously hidden gaps in mental health services have become glaringly apparent shortcomings of the current American healthcare model.

A 2021 meta-analysis published in the Lancet emphasized that the pandemic increased the rates of depression and anxiety while distancing communities from the resources they could previously access to handle them.

In an article published by the American Psychiatric Association (APA) reviewing the results of a COVID-19 impact survey completed by healthcare providers, the organization noted that 46% of healthcare practitioners have been unable to meet treatment demands. The pandemic resulted in roughly 60% of providers being unable to see new patients and 72% having longer wait lists.

“Having timely access to psychological services is critical for addressing the needs of those diagnosed with behavioral health challenges,” said APA CEO Arthur C. Evans Jr., PhD, in the APA article.

“But we need to tackle this problem with a variety of solutions beyond individual therapy. We need to support and expand the workforce, promote integrated behavioral health into primary care, improve mental health literacy, use technology and innovation to expand reach and improve efficiency.”

Types of Behavioral Health Treatments

Behavioral health services can include a combination of the following tools:

  • Mental health screenings, initial interventions, and treatment referrals
  • Psychotherapy
  • Medication or devices
  • Residential treatment
  • Case management
  • Engagement or outreach programs
  • Skill development
  • Peer support groups
  • Family member services
  • Crisis response services

Across the US, many populations experience healthcare inequities, especially regarding mental disorders or treatments.

Barriers to Care

In a 2020 article in Focus: The Journal of Lifelong Learning in Psychiatry, researchers define a treatment gap as the difference between the number of people with a condition and the number of people being treated for it. The article estimates the global mental health treatment gap is over 50% across all countries. In low-income countries, the gap can be significantly higher, reaching 90%.

Researchers in Focus note, “the weighted mean for the treatment gap in North America for moderate to severe mental disorders is 65.7%.”

Beyond the prevalence of untreated mental health problems, many psychiatric disorders are managed by primary care physicians (PCPs) rather than specialized mental health professionals.

Multiple factors contribute to the persistent treatment gaps. While some gaps, like the stigma surrounding mental health, are unique to this care sector, others, like insurance coverage, are a byproduct of an imperfect health system. The most common barriers to care include insurance coverage, stigma, workforce shortages, and location. Each factor presents a unique challenge that requires varying solutions.

Community-Based Barriers

Although the challenges in the mental health system can be broadly divided by type of challenge, it is crucial to understand how they affect different patient populations, as that may alter community-based approaches.

One group that experiences the mental health treatment gap is sexual and gender minority groups, which often face stigmas in everyday life, including healthcare experiences.

Racial and Ethnic Minorities

Racial and ethnic minorities are more likely to have limited access to mental health treatment than their White counterparts. When they can access treatment, they often have lower-quality care.

Closing the treatment gap for racial and ethnic minorities requires a multi-faceted approach. According to Focus, there are few community-based interventions and partnerships, resources, and accessible, evidence-based services for these communities.

One of the factors driving treatment gaps in these communities is unconscious bias and stereotypes. Despite disease epidemiology showing that Black people are more likely to experience severe depression, they have lower treatment rates linked to discrimination.

Addressing this treatment gap requires cultural competency initiatives, where clinicians are educated on sociocultural backgrounds and how they may impact mental health, disease presentation, and help-seeking behaviors.

Another unmet need is diversity in clinical research. Like nearly all clinical studies, mental health trials rarely represent the affected disease population, with most participants being White. Clinical trials for mental health disorders need to represent the existing patient population more to allow researchers and healthcare professionals to identify the most effective tools for each patient.

Mental Health Gap Action Program

Aside from domestic initiatives, collaborative global mental health initiatives, with efforts from the World Health Organization (WHO) and the National Institutes of Mental Health (NIMH), have focused on reaching underserved communities. On a global scale, the WHO is focused on low- and middle-income countries, looking for cost-effective treatment options.

The WHO has a Mental Health Gap Action Program (mh-GAP), launched in 2008, to provide tools for mental, neurological, and substance use disorders. The WHO’s mh-GAP links 14% of the global disease burden to mental, neurological, and substance use disorders.

“The time has come for health providers and policymakers to come together and implement an action plan to improve care for millions of mental health patients in the United States. All these changes will serve the needs of people experiencing mental disorders and advocate for the respect of their human rights,” concluded researchers in Focus.

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