Professional News
Mental Illness Treatment Still Elusive for Many
Psychiatric News
Volume 40 Number 14 page 10-11

In the past decade, the use of mental health treatment in the United States has dramatically increased. Still, many Americans are not receiving minimally adequate care for mental illness.

That's one of numerous findings from the National Comorbidity Survey Replication (NCS-R), published in the June Archives of General Psychiatry in four papers. The NCS-R is a follow-up of the National Comorbidity Survey, whose results provided an overview of Americans' mental health a decade ago.

The lead author of the NCS-R was Ronald Kessler, Ph.D., a professor of health care policy at Harvard Medical School. Other researchers, including psychiatrists, were involved as well.

Although results from the survey are extensive, five major findings stand out:

Pincus said that he was surprised at "how few people had minimally adequate care— even those seen by psychiatrists, and even those with pretty significant conditions."

Philip Wang, M.D., Ph.D., told Psychiatric News that he was surprised by this finding as well. Wang is an assistant professor of psychiatry at Harvard Medical School and one of the survey authors.

The irony, Wang said, is "that despite the fairly dramatic increase in the use of mental health treatments that has occurred over the past decade, the adequacy of treatments received by individuals really hasn't improved."

Nonetheless, while increased use of mental health treatments does not appear to have benefited the public as a whole, undoubtedly individual patients have improved because of them, Kenneth Wells, M.D., believes. Wells is a professor in residence in psychiatry at the University of California at Los Angeles and one of the survey authors.

"The NCS-R study offers some new exploratory data that, along with other research studies, stand to have an impact on the mental health field and need to be further validated in order to understand the greater implications of the findings," Darrel Regier, M.D., said in an APA press release issued in conjunction with publication of the NCS-R results. "It is important to note that new findings typically need replication and validation."

Regier is director of the APA Division of Research and the American Psychiatric Institute for Research and Education.

"The findings reported here are the first of what promises to be a bountiful harvest," Thomas Insel, M.D., and Wayne Fenton, M.D., wrote in an editorial accompanying publication of the results. "The NCS-R is one element in a coordinated program of new psychiatric epidemiological studies that will be completed over the next several years." Insel is director of the National Institute of Mental Health (NIMH); Fenton is director of the Division of Adult Translational Research and associate director for clinical affairs at NIMH.

The NCS-R was based on interviews of a nationally representative sample of Americans conducted from 2001 to 2003. More than 9,000 subjects aged 18 and older were interviewed using the World Mental Health Survey version of the Composite International Diagnostic Interview, which generates diagnoses of mental disorders in accord with DSM-IV.

The study was funded by the NIMH, National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, Robert Wood Johnson Foundation, and John W. Alden Trust.

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