Background-Although the 1990s saw enormous change in the US mental health care system, little is known about changes in prevalence or treatment of mental disorders.

Objective Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation are to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement (NCS-A). Method Face-to-face survey of mental disorders from 2002-2004 using a modified version of the fully-structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents aged 13-18 years for whom information on service use was available from both an adolescent and a parent report. Both total and sector-specific mental health service use was also assessed. Results Approximately one-third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest among those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but less than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly among youth with behavior disorders. Hispanic and non-Hispanic black adolescents were less likely than their white counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. Conclusions Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.

Most people with mental disorders in the United States remain either untreated or poorly treated. Interventions are needed to enhance treatment initiation and quality.

Failure to make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care in the United States. Interventions to speed initial treatment contact are likely to reduce the burdens and hazards of untreated mental disorder.

RESULTS:The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.