A new study of the use of mental health care services among adults in California has been published (with full pdf text). Who Gets Needed Mental Health Care? Use of Mental Health Services among Adults with Mental Health Need in California (Tran & Ponce, 2017), examines the records of mental health consumers over four years. Findings are startling, but sadly not surprising. For example, in 2013, it was estimated that 2.2 million people in California needed mental health services. However, 77% of that 2.2 million did not receive mental health services. Nearly 8 of 10. Those at the intersection of economic security, age, learning, and language were the most impacted, including men, Latinos, older adults, and those with less education and non-English speakers (Tran & Ponce, 2017).
More specifically, stigma played a huge role in determining lack of care.
When asked why they did not see a health professional in the past year, a majority (64%; 354,000) of adults with mental health need who felt they needed help endorsed cost of treatment as a reason; 47% (261,000) indicated that they “did not feel comfortable talking with a health professional” or were concerned if “someone found out [they] had a problem;” and one of five (20%; 109,000) adults said they had difficulty getting an appointment.
When 261,000 people are afraid of someone finding out they need help for a problem, we have a problem. Imagine 261,000 people with diabetes not getting insulin because they were afraid that someone would find out they had a problem. Imagine 261,000 people with chest pain not getting help because they were afraid someone would find out.
What would happen? A large number of them would die. We figured this out during the early days of AIDS/HIV. As the number increased, as we all began to know someone who had in one way or another been effected, we dropped fear and increased knowledge. We put research dollars to the problem. We learned what it was and was not. We embraced those infected, we supported communities devastated by the disease. We corrected each other, demanded our institutions not discriminate. We beat stigma. We saved lives.
Why not mental illness? Is the stigma of mental illness somehow different? From the research I have done over the past decade I feel comfortable saying a resounding , NO. It is the same stigma that separated lepers in Biblical times.
Stigma is not a choice, it is a rule of the road that those with mental illness know intimately. It is not merely “feeling” afraid that someone would use the information inappropriately or harmfully. It is direct knowledge that in fact they would be harmed. Stigma is not an abstract hashtag or fundraiser. Stigma is not an issue of diversity, inclusion, or fluidity on an abstract spectrum of identity. Stigma stops people who need help from getting help.
When 261,000 people who need help and can’t get it, one wonders how bad the alternative must be? Loss of family, shelter, job, relationships, food security, freedom, custody of children. As a mother, I would risk diabetes, heart attack or shark attack to avoid anything that would jeopardize my life with my children. I will follow the rules of the road; and in Los Angeles…we have freaking freeways.
Tran, L. D., & Ponce, N. A. (2017). Who Gets Needed Mental Health Care? Use of Mental Health Services among Adults with Mental Health Need in California.