Unmet Need for Mental Health Care in Schizophrenia: An Overview of Literature and New Data From a First-Admission Study

Abstract

We present an overview of the literature on the patterns of mental health service use and the unmet need for care in individuals with schizophrenia with a focus on studies in the United States. We also present new data on the longitudinal course of treatments from a study of first-admission patients with schizophrenia. In epidemiological surveys, approximately 40% of the respondents with schizophrenia report that they have not received any mental health treatments in the preceding 6-12 months. Clinical epidemiological studies also find that many patients virtually drop out of treatment after their index contact with services and receive little mental health care in subsequent years. Clinical studies of patients in routine treatment settings indicate that the treatment patterns of these patients often fall short of the benchmarks set by evidence-based practice guidelines, while at least half of these patients continue to experience significant symptoms. The divergence from the guidelines is more pronounced with regard to psychosocial than medication treatments and in outpatient than in inpatient settings. The expansion of managed care has led to further reduction in the use of psychosocial treatments and, in some settings, continuity of care. In conclusion, we found a substantial level of unmet need for care among individuals with schizophrenia both at community level and in treatment settings. More than half of the individuals with this often chronic and disabling condition receive either no treatment or suboptimal treatment. Recovery in this patient population cannot be fully achieved without enhancing access to services and improving the quality of available services. The recent expansion of managed care has made this goal more difficult to achieve.

Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project

“…Availability of family support and community integration may contribute to differences in outcomes 8 , but a particularly salient issue is access to treatment. The Suffolk County cohort received community services typical of the U.S. and experienced a substantial unmet need for care 30 , which may account for poor outcomes especially compared to countries with universal health care.…”

Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders

“…In our sample, 93% (25/27) of study participants were taking antipsychotic medications and 67% (18/27) were seeing a psychiatrist. These rates of mental health care use are much higher than the general CPD population in the United States, where at least 40% of people with CPD have no contact with mental health services [52]. As CLIMB has been designed to meet the needs of those who are unable or unwilling to come in to mental health clinics to access treatments for social functioning, future research will seek to recruit a mixed sample of service users directly drawn from diverse community-based settings and non-service users in order to examine engagement patterns on a more representative sample of patients with CPD.…”

An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges

“…However, for many there is limited access to EBIs that may prove effective in supporting hope and restoring confidence and competence [43]. Mojtabai et al [44] found that more than 50% of people with schizophrenia received either no treatment or suboptimal treatment. Torres-González et al [45] identified six areas of specific need: frequent complications and co-morbidities (e.g., substance misuse); psychological, social and economic needs; early interventions to reduce illness progression; treatment augmentation with rehabilitation EBIs; maintenance of service contacts; and greater research efforts into existential needs.…”