摘要：Objectives . The purpose of this study was to assess the prevalence and correlates of treatment for serious mental illness. Methods . Data were derived from the National Comorbidity Survey, a cross-sectional, nationally representative household survey assessing the presence and correlates of mental disorders and treatments. Crude and adjusted likelihoods of receiving treatment for serious mental illness in the previous 12 months were calculated. Results . Forty percent of respondents with serious mental illness had received treatment in the previous year. Of those receiving treatment, 38.9% received care that could be considered at least minimally adequate, resulting in 15.3% of all respondents with serious mental illness receiving minimally adequate treatment. Predictors of not receiving minimally adequate treatment included being a young adult or an African American, residing in the South, being diagnosed as having a psychotic disorder, and being treated in the general medical sector. Conclusions . Inadequate treatment of serious mental illness is an enormous public health problem. Public policies and cost-effective interventions are needed to improve both access to treatment and quality of treatment. Serious mental illness, defined in federal legislation as a mental disorder that substantially interferes with one's life activities and ability to function, has been estimated to afflict 5.4% of the US adult population each year. 1, 2 Concerns about the levels of treatment received by those with serious mental illness have been growing as a result of recent changes in social welfare policy and mental health care delivery systems. 3 In response, the federal government passed Public Law 102-321, the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act, establishing block grants for states to fund community mental health services exclusively for patients with serious mental illness who are unable to pay for care. Funds allocated under these block grants amount to less than $50 per year for each individual with serious mental illness living in poverty. 1, 2 For these reasons, concerns persist that patients with serious mental illness fail to receive adequate care. Such concerns have sparked a debate over the priority that should be given to the treatment of people with serious mental illness in redesigned public insurance schemes. 4– 7 Few empiric data exist on patterns of treatment among people with serious mental illness. Through the use of data from the National Comorbidity Survey (NCS) and the Epidemiologic Catchment Area Study, it has been estimated that roughly half of those with serious mental illness receive some form of treatment in a given year. 1, 2, 8 Although this estimate is disturbingly low, the effective treatment rate could be even lower. A growing body of literature suggests that mental health treatments, if they are to be effective, must conform with evidence-based guidelines regarding type of treatment, intensity of treatment, and duration of treatment. 9– 13 Previous studies have shown that a substantial proportion of people in treatment for mental disorders do not receive minimally acceptable care. 14– 17 It is not implausible that the same is true for the subset of patients with serious mental illness. The present study was undertaken to address 2 aims. First, we sought to use a large, nationally representative general population survey to estimate the proportion of people with serious mental illness who receive care consistent with available evidence-based treatment recommendations. 18– 23 Second, we sought to identify correlates of receiving any treatment and receiving minimally adequate treatment. Identifying such correlates is a critical first step in developing and targeting interventions to improve the appropriateness of care and health outcomes of those with serious mental illness.
