Treating Behavioral Health Conditions in the United States

Nearly 57 million American adults had a mental health condition (such as depression), a substance use disorder, or both in 2017—and 70% of them didn’t receive treatment for these conditions.

Left untreated, these behavioral health conditions can cause other health complications, such as drug overdoses.

So, for Mental Illness Awareness Week, the WatchBlog looks at why so many people with these conditions go untreated, and efforts to increase access to treatment.

An untreated majority

Treatment for behavioral health conditions can help people reduce or stop substance abuse, manage their symptoms, and improve their quality of life. However, we found that the vast majority of people with these disorders don’t think they need treatment.

Possible reasons for this include:

  • Inability or unwillingness to recognize a behavioral health condition
  • Pessimism about the effectiveness of treatments
  • Preference for self-reliance

There are also millions of people who know they need help but still don’t get treatment for their conditions. These individuals cite reasons like cost, stigma, and not being able to access treatments (e.g., not knowing where to go for care or not having treatment options nearby).

Access challenges

Certain groups, such as low-income adults, have more trouble accessing treatment for behavioral conditions than others. For example, hourly wage workers may not be able to get time off from work for treatment, and those who are homeless may have to put other priorities first—such as finding shelter.

Some people also find it hard to access treatment because they aren’t close to treatment providers. This is partly due to a national shortage of behavioral health care professionals. For instance, 55% of the counties in the United States—all rural—don’t have any practicing behavioral health workers, according to the Department of Health and Human Services (HHS).

A way forward

To help address this shortage, states have been increasingly turning to peer support specialists—people who use their own experiences recovering from mental illnesses to support others. (Their services are meant to complement, not replace, clinical services.)

These specialists work in a variety of settings, such as emergency rooms, independent peer-run organizations, and in housing agencies that help low-income families and people with disabilities find rental housing.

Some states receive federal funding from HHS for peer support specialist programs. We reviewed how these programs screen, train, and certify specialists, and identified 6 leading practices—such as training specialists in person and requiring continuing education. Learn more in our report.


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