Mental health care in the U.S. underwent significant changes over the past decade. New regulations mandated increases in mental health coverage, while state budget cuts for mental health services have resulted in the largest total cuts to such spending since the 1970's. But what does the public think?
Experience of mental health issues
Pollsters face a dilemma when asking about an issue as sensitive as personal experience with mental illness. Significant under reporting is to be expected. But even given this caveat, polling reveals that Americans have a great deal of personal experience with mental illness.
The proportion of Americans reporting that they know someone who suffers from a mental health problem has stayed surprisingly consistent, despite increased willingness to discuss such issues. About a third of the country reported knowing someone with a mental illness in both the 1950's and the 1990's, while more recent polls found about six in ten have ever known someone who received treatment or was hospitalized for a mental illness. Polls in the last decade have found as many as one in six reporting having experienced a mental health problem themselves.
Mental health as a health problem
Given widespread personal experience, it is not surprising that a majority see mental illness as a serious public health problem. A 2013 Pew poll found that 67% of the public believed that mental illness was an extremely or very serious public health problem. Moreover, a 2006 Parade/Research!America poll found that, though nearly everyone (89%) believed that physical and mental health were equally important, two-thirds believed that physical health was treated with greater importance in our current health care system.
But questions about how mental health ranks as a public health problem imply that these conditions are primarily health issues, a categorization that some of the public has shown reluctance to make in historical polls, which reveal uncertainty over the role personality and character play in mental health problems. As recently as 1996, more than half the country believed that depression was a sign of personal or emotional weakness, while only 38% described it as a health problem. More recent polls have not delved deeper into this idea, but instead have asked whether seeking treatment for such issues is a sign of weakness. On this point, Americans in polls in the early 2000's were certain – fewer than one in five said treatment indicates weakness.
Stigma of mental illness
In a 1978 General Mills/Yankelovich, Skelly & White poll of adult members of families, 81% said they welcomed the “more open talk” in society about mental illness. Despite the lauded increase in openness, a majority of Americans continue to perceive a stigma attached to mental illness decades later – 82% in a 2002 poll. A 55% majority in a 2004 Parade/Research!America poll, however, did think that the stigma around depression specifically had been lifted in recent years.
Americans don’t just perceive stigma around mental illness, a substantial share also admit to having negative feelings about the mentally ill. Substantial proportions report they would feel at least somewhat uncomfortable working with or living next to someone with a serious mental illness, while two-thirds of parents would feel uncomfortable if someone with such a problem worked in their child’s school.
Treatment of mental health issues: Drugs
Prozac was approved for treatment of depression in the U.S. in 1987 and quickly transformed the world of antidepressants. The success of this drug and others that followed prompted a national discussion about the value of medications to manage mental health issues. In a 1996 poll, 41% of Americans believed that depression could be successfully treated by medication almost all or most of the time. Interestingly, a somewhat larger share (58%) believed that depression could be successfully treated by therapy and counseling most of the time. A similar pattern was found in a poll the same year on anxiety disorders. By 2005, 42% of the public believed that prescription drugs developed over the past 20 years had made a big difference in the lives of people with mental illness.
Treatment of mental health issues: Mental health professionals
Americans may believe in the potential value of therapy, but a substantial minority has viewed practitioners with skepticism, with 38% in a 2004 poll saying they believed most therapists are in need of therapy themselves. Although the ratings for honesty and ethical standards of psychiatrists have improved slightly since the 1970's, the field’s reputation is at best middling compared to other health professionals. In 2012, psychiatrists received lower ratings than doctors, nurses, pharmacists and even dentists.
Costs and coverage for mental health issues
Ninety-three percent of the public in a 1997 National Mental Health Association/Opinion Research Corporation International said that health insurance companies should provide the same coverage for mental health problems as they did for physical health problems. But at the time, few reporting having insurance with such coverage. Only 35% of the country, in a 1996 National Mental Health Association/Wirthlin Group, believed that mental health services would be mostly covered by their insurance, while 30% believed coverage would be partial. A 2006 American Psychological Association/National Women’s Health Resource Center/iVillage poll similarly found only 29% believed their insurance offered full benefits for mental health services. This failure of coverage may explain why, despite indications that Americans believe in the efficacy of therapy, a 43% plurality in a 2004 Psychology Today/PacifiCare Behavioral Health poll said that the costs of therapy generally outweigh the benefits.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) addressed these issues by requiring group health plans and health insurance issuers to provide mental health benefits in parity with other medical benefits. The Affordable Care Act of 2010 (ACA) further increased availability of mental health coverage by requiring that most health plans cover mental health services. Americans may have supported these changes, but unfortunately, many don’t appear to know about them. Thirty-eight percent of the public in a 2013 Kaiser poll were aware of requirements for parity of mental health services, while 40% believed insurance companies could have separate rules for mental health benefits.
Despite these changes, 12% of Americans in 2013 reported that they or a household family member had problems getting mental health care in the last year because of costs. Unfortunately, with state budgets for mental health care continuing to be cut, many more people in need of help may have trouble getting it.