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Shortfall in mental health service utilisation
Open accessAbstract
Background: Treatment coverage for mental disorders is poor in most developed countries. Aims: To explore some reasons for the poor treatment coverage for mental disorders in developed countries. Method: Data were taken from Australian national surveys and from the World Health Report. Results: Only one-third of people with a mental disorder consulted. Probability of consulting varied by diagnosis: 90% for schizophrenia, which is accounted for by external factors; 60% for depression; and 15% for substance use and personality disorders. The probability of consulting varied by gender, age, marital status and disability, from 73% among women aged 25–54 years, disabled and once married to 9% among males without these risk factors. Those who did not consult but were disabled or comorbid said that they “preferred to manage themselves”. Data from five countries showed no evidence that overall health expenditure, out-of-pocket cost or responsiveness of the health system affected the overall consulting rates. Conclusions: Societal, attitudinal and diagnostic variables account for the variation. Funding does not. Public education about the recognition and treatment of mental disorders and the provision of effective treatment by providers might remedy the shortfall.
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“Only 35% of young people experiencing mental health problems seek professional face-to-face help [91,92].”
From Do online mental health services improve help-seeking for young people? A systematic review (2014) · cites this paper as [92]
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“However, only 16.7% of people who suffer from anxiety disorders seek help from a mental health professional, and of these individuals, only 21.3% receive CBT, which is arguably the most effective treatment [8].”
From Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. (2014) · cites this paper as [8]
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“Despite the severity of these consequences, it is estimated that up to one-half of those with depression [16-18] and only one third to one-half of those affected by anxiety disorders [8,16] seek professional help.”
From A systematic review of help-seeking interventions for depression, anxiety and general psychological distress (2012) · cites this paper as [8]
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“However, only 16.7% of people who suffer from anxiety disorders seek help from a mental health professional, and of these individuals, only 21.3% receive CBT, which is arguably the most effective treatment [8].”
From Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. (2014) · cites this paper as [8]
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“As described by Andrews et al (2001), according to a collation of data from the Australian National Survey of Mental Health and Wellbeing and the World Health Report, only a third of individuals with a mental disorder sought treatment [29].”
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“This contrasts with the general suggestion of higher utilisation in deprived groups [27,28], but corresponds to findings from Norway [22] and the US [29].”
ResultMen’s Help Seeking for Depression: The Efficacy of a Male-Sensitive Brochure About Counseling
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“Together with evidence that the majority of people prefer to manage on their own, including a substantial proportion with comorbid conditions [37], the potential for computer-based self-help treatments is promising.”
BackgroundPierce, M., Abel, K. M., Muwonge, J. J., Wicks, S., Nevriana, A., Hope, H. F., Dalman, C., & Kosidou, K. (2020) · The Lancet Public Health · doi:10.1016/s2468-2667(20)30202-4 · Cited by 73
The Influence of Social Anchorage on the Gender Difference in the Use of Mental Health Services
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“Even when the diagnosis is correctly made, the treatment that is received tends to be suboptimal in > 50% of patients [20-22].”
BackgroundAnxiety during the COVID-19 pandemic in hospital staff: systematic review plus meta-analysis
Raoofi, S., Kan, F. P., Rafiei, S., Khani, S., Hosseinifard, H., Tajik, F., Masoumi, M., Raoofi, N., Ahmadi, S., Aghalou, S., et al. (2021) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2021-003125 · Cited by 63
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“Self-perception with regard to mental health or attitudes toward health services may account for differences between males and females [80].”
BackgroundAn information-processing model of the decision to seek professional help.
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“Most of those with a perceived need for care, who are in absolute number a minority of patients with a DSM-IV diagnosis, prefer not-effective treatment such as information or social support [ 36 ].”
BackgroundPerceived unmet need and barriers to care amongst street‐involved people who use illicit drugs
Hyshka, E., Anderson, J. T., & Wild, T. C. (2016) · Drug and Alcohol Review · doi:10.1111/dar.12427 · Cited by 60
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“…more likely to exhibit suicidal behaviors, males are less likely to perceive a need for, and to seek help for their depression compared to females (Andrews et al., 2001b; Australian Bureau of Statistics, 2016; Burgess et al., 2009; Hengartner et al., 2016; Kessler et al., 2005a; Mackenzie et al.,…”
BackgroundSelf-citationChristoforou, M., Sáez Fonseca, J. A., & Tsakanikos, E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7747 · Cited by 48
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“Reasons for this lack of utilization of formal services include inaccessibility of services (38, 39), scepticism about treatment (40, 41), perceived need for treatment (42, 43), self-stigma (44), a preference for selfmanagement (45), and lack of insight (46).”
BackgroundRelationships among personality, expectations about counseling, and help-seeking attitudes
Kakhnovets, R. (2011) · Journal of Counseling & Development · doi:10.1002/j.1556-6678.2011.tb00056.x · Cited by 85
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“on the uptake and adherence to recommended treatments and may contribute to the low rate of seeking treatment for common mental disorders (Andrews et al., 2001).”
BackgroundHelp-Seeking Attitudes and Behaviors Regarding Mental Health among Turkish College Students
Bilican, F. I. (2013) · International Journal of Mental Health · doi:10.2753/imh0020-7411420203 · Cited by 48
“While 77 percent of individuals under psychological treatment carry a diagnosis, those who experience mild psychological difficulties without a diagnosis seek less help [8].”
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“receiving rates in individuals with a subclinical depression range between 1% and 32% (Andrews et al., 2001).”
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“This is consistent with the Australian NSMHWB, as well as research conducted in the USA, Canada and the Netherlands [45, 46].”
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“Epidemiological studies across different nations show that individuals rarely access and use health services for mental distress [2-6].”
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“This population based research is particularly important, since the majority of individuals with a disorder may never seek clinical help [2], and studies of subjects drawn from clinical settings may therefore not be representative of the broader community.”
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“Mental disorders can have severe consequences if untreated, including disability [6,7], suicide [8], lowered quality of life [9], and, for students, a greater risk of dropout from their education [10].”
Middle Eastern Americans: The Effects of Stigma on Attitudes Toward Counseling
Soheilian, S. S., & Inman, A. G. (2009) · Journal of Muslim Mental Health · doi:10.1080/15564900903245766 · Cited by 63
Metadata
- Authors
- Andrews, G., Issakidis, C., & Carter, G.
- Affiliations
- UNSW Sydney (AU)
- Corresponding author
- Andrews, Gavin
- ORCID
- Andrews, Gavin
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2001-11
- Volume
- 179
- Issue
- 5
- Pages
- 417-425
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2082102545
- Cited by
- 420
- References
- 27
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 8 · 2023: 7 · 2022: 17 · 2021: 20 · 2020: 16 · 2019: 15 · 2018: 20 · 2017: 18 · 2016: 19 · 2015: 23 · 2014: 33 · 2013: 25 · 2012: 24
- FWCI
- 13.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- mental health service utilization, treatment coverage, help-seeking, mental illness, schizophrenia, depression, substance use disorders, personality disorders, gender differences, disability, comorbidities, self-management, health care costs, out-of-pocket costs, health system responsiveness, mental health funding, public education
- MeSH terms
- Adolescent, Adult, Aged, Attitude to Health, Australia, Mental Disorders, Female, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Perception, Regression Analysis, Sex Factors, Socioeconomic Factors, Odds Ratio
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