Clinical Need, Perceived Need, and Treatment Use: Estimating Unmet Need for Mental Health Services in the Adult Population

Abstract

Estimates of unmet need for mental health services in the adult population are too high because many recover without treatment. Untreated recovery suggests that individuals accurately perceive professional help as unnecessary and do not pursue it. If so, perceived need for treatment should predict service use/nonuse more strongly than the presence or seriousness of disorder. With National Comorbidity Survey-Replication data, respondents who recovered from prior disorder by the current year (N = 1,054) were compared to currently unrecovered respondents with less serious (N = 999) and more serious disorders (N = 294). Perceived need covaried positively with the presence and seriousness of disorder and linked to far higher odds of treatment use than disorder seriousness, supporting perceptual accuracy. Two-thirds of respondents who perceived a treatment need obtained care; only one-third had unmet need. Need perceptions may better estimate a treatment gap and prompt research on individuals’ self-assessments and treatment decision-making.

Barriers to Care among High Emergency Department Users with Mental Disorders – A Mixed Methods Study

“…Some qualitative studies that explored high ED use among patients with MD found that unmet care needs partly explained high ED use [10][11][12]. Previous quantitative investigations have found that, compared to patients with MD who have few or no needs, patients with unmet care needs were more likely to be women, younger, and have severe MD symptoms, co-occurring MD-SRD or poor physical health conditions [13,14]. A study found that unmet care needs correlated more closely with ED use when such use was related to a patient's management of their psychiatric symptoms (i.e., safety to self/others, substance use, psychological distress, medication), followed by basic (i.e., housing, food, money) and social needs (i.e., friends, community) [6].…”

“…A better understanding of the high psychiatric ED use among this population may help recommend interventions that are more patient-centered. Past studies mostly compared patients with met or unmet care needs without considering the impact of barriers to care [14,18]. It seems crucial to determine whether all patients with high ED use have more perceived care barriers or unmet needs and, if it's not the case, to compare the reasons explaining high ED use in those patients.…”