Mental Illness and Treatment by the Numbers

According to the 2024 National Survey on Drug Use and Health (NSDUH):

• Approximately 1 in 5 adults (23.4%) experienced any mental illness, representing 61.5 million people
• About 1 in 20 adults (5.6%) experienced serious mental illness, or 14.6 million people
• Nearly 1 in 5 adolescents (18.8%) aged 12-17 experienced moderate or severe symptoms of generalized anxiety disorder
• Over 1 in 5 adults (21.7%) reported symptoms of generalized anxiety disorder
• 50.6% of U.S. youth aged 6-17 with a mental health disorder received treatment in 2016. However, there were some differences between treatment rates by category of disorder (Figure 1). For example, children with anxiety disorders were least likely to have received treatment in the past year, while children with ADHD or a conduct disorder were more likely to receive treatment. Can you think of some possible reasons for these differences in receiving treatment?
• The average delay between the onset of mental illness symptoms and treatment is 11 years^[1]

 

Treatment Rates

Treatment rates vary by severity of illness and age group:

• Among adults with any mental illness, 52.1% received mental health treatment in the past year
• Among adults with serious mental illness, 70.8% received treatment
• Among adolescents, approximately one-third received mental health services, with outpatient treatment being the most common form

While treatment rates have improved over time, a significant treatment gap remains. Among those who do not seek help, the most common reason cited is believing they can handle their mental health on their own—a form of stigma that prevents many from accessing care.

Disparities in Treatment Access

Treatment access is not equal across populations. According to SAMHSA data, White and Multiracial adults are more likely to receive mental health services than Black, Hispanic or Latino, or Asian adults. Additionally, adults aged 50 or older are less likely to receive treatment via telehealth or outpatient services compared to younger adults.

Treatment Today

Community-Based Care

Today, community mental health centers operate across the nation, located in neighborhoods near the homes of clients. These centers provide a range of services for various mental health conditions, including:

• Outpatient treatment (individual and group therapy)
• Case management
• Crisis intervention
• Medication management
• Supportive housing assistance

Community Service Boards (CSBs) are local mental health agencies that coordinate many of these services. Many services are offered on a sliding-fee scale, making them accessible to those with limited financial resources.

The 988 Suicide and Crisis Lifeline

In July 2022, the United States launched 988, a three-digit number that connects callers to the Suicide and Crisis Lifeline. This service provides 24/7 free and confidential support via phone, text, or chat. Since its launch, 988 has received over 16 million contacts. Research shows that most people who contact 988 report receiving the help they needed, though awareness of the service remains limited—only about 23% of Americans report being familiar with it (NAMI, 2024).

Telehealth Expansion

The COVID-19 pandemic dramatically accelerated the adoption of telehealth for mental health services. By late 2023, approximately 37% of mental health visits were conducted via telehealth, making mental health the leading use of telehealth services in the United States. Research demonstrates that telehealth is as effective as in-person care for many common mental health conditions.

Telehealth has proven particularly valuable for reaching rural and underserved populations, where in-person mental health providers are scarce. However, challenges remain, including limited internet access in some areas and the need for in-person care for certain conditions.

Psychiatric Hospitalization

Inpatient Care Today

Rather than the large asylums of the past, today’s psychiatric care takes place in hospitals run by state governments, local community hospitals, and private facilities. The emphasis is on short-term stays, with the average length of hospitalization typically less than two weeks and often only several days.

Several factors contribute to shorter stays: the high cost of psychiatric hospitalization (approximately $800-$1,000 per night), insurance limitations, and the philosophy of treating people in the least restrictive setting possible. The number of state psychiatric hospital beds has declined to a historic low of 10.8 beds per 100,000 people in 2023 (Treatment Advocacy Center, 2024).

Usually, individuals are hospitalized only if they pose an imminent threat to themselves or others, or are unable to care for their basic needs.

Unfortunately, part of what occurred with deinstitutionalization was that those released from institutions were supposed to go to newly created centers, but the system was not set up effectively. Centers were underfunded, staff was not trained to handle severe illnesses such as schizophrenia, there was high staff burnout, and no provision was made for the other services people needed, such as housing, food, and job training. Without these supports, those people released under deinstitutionalization often ended up homeless.

Even today, a large portion of the unhoused population is considered to be mentally ill. Statistics show that 26% of unhoused adults living in shelters experience mental illness (U.S. Department of Housing and Urban Development [HUD], 2011).

Mental Illness in the Criminal Justice System

People with mental illness are significantly overrepresented in the criminal justice system. According to SAMHSA, approximately 44% of those in jail and 37% of those in prison have a mental illness—compared to about 23% of the general adult population. An estimated 63% of people in jail and 58% in prison have a substance use disorder.

This situation has led some to describe jails and prisons as “the new asylums.” The largest county jails—Los Angeles County Jail, Chicago’s Cook County Jail, and New York’s Rikers Island—each hold more people with mental illness than any remaining psychiatric hospital (Treatment Advocacy Center, 2024).

Recognizing these challenges, many communities have developed alternatives:

• Mental health courts divert individuals with mental illness from incarceration to treatment
• Crisis Intervention Team (CIT) training teaches law enforcement to respond more effectively to mental health crises
• Mobile crisis teams provide mental health professionals to respond alongside or instead of police
• Pre-arrest diversion programs connect people to services before they enter the criminal justice system

Residential Options

For individuals who need ongoing support but not hospitalization, several options exist:

• Group homes provide community living with staff support and structured activities
• Assisted living facilities offer more independent living with supportive services like medication management
• Supported housing programs help individuals maintain independent apartments with case management support

These options can provide individuals with a sense of community while allowing them to live more independently than in institutional settings.

Routes to Treatment

Most people with mental illness are not hospitalized but receive treatment in outpatient settings. People enter treatment through various pathways:

• Self-referral: An individual experiencing symptoms like depression, anxiety, or hearing voices might seek help on their own, often starting with a primary care physician who refers them to a mental health specialist.
• Family involvement: A spouse, parent, or friend might encourage someone to seek treatment or help them find a provider.
• Child welfare system: Parents involved with child protective services may be required to attend treatment, while children who have experienced abuse or neglect often receive trauma-focused therapy.
• Criminal justice system: Some individuals are required to attend therapy as a condition of parole or probation, while others may be diverted to treatment programs rather than incarceration.

involuntary and voluntary treatment

Involuntary treatment refers to therapy that is not the individual’s choice; if an individual is mandated to attend therapy, they are seeking services involuntarily.

Voluntary treatment means the person chooses to attend therapy to obtain relief from symptoms.

Treatment Settings and Providers

Mental health treatment occurs in diverse settings:

• Private practice offices of psychologists, psychiatrists, and counselors
• Community mental health centers
• Primary care clinics (integrated behavioral health)
• Schools (counselors, psychologists, social workers)
• Correctional facilities
• Telehealth platforms

Multiple types of professionals provide mental health services, including:

• Psychiatrists (medical doctors who can prescribe medication)
• Psychologists
• Licensed clinical social workers
• Licensed professional counselors
• Marriage and family therapists
• Psychiatric nurse practitioners
• Peer support specialists (individuals with lived experience of mental illness)

Licensing requirements vary by state, and scope of practice differs among provider types.

Barriers to Treatment

The Workforce Shortage

The United States faces a significant shortage of mental health professionals. As of 2023, approximately 169 million Americans—more than half the population—live in Mental Health Professional Shortage Areas. Over 8,000 additional providers would be needed to meet current demand (Commonwealth Fund, 2023).

The shortage is particularly acute in rural areas. More than half of U.S. counties have no practicing psychiatrist, and 70% of counties have no child and adolescent psychiatrist. In many rural communities, primary care physicians and law enforcement become the de facto first-line mental health responders, though they often lack specialized training.

Financial Barriers

The cost of mental health care remains a significant barrier for many people. However, the Mental Health Parity and Addiction Equity Act of 2008 requires insurance plans to provide mental health coverage that is no more restrictive than coverage for physical health conditions. This means co-pays, visit limits, and deductibles for mental health services cannot be more restrictive than those for medical or surgical care.

Despite parity laws, practical barriers remain: many mental health providers do not accept insurance, waitlists can be long, and even with insurance, co-pays and deductibles can be substantial.

Stigma

Perhaps the most pervasive barrier is stigma—the negative attitudes and discrimination that people with mental illness face. According to SAMHSA data, the most common reason people with mental illness do not seek treatment is believing they can handle it on their own. Stigma can also manifest as:

• Fear of being judged by others
• Concerns about confidentiality
• Worry about the impact on employment or relationships
• Internalized beliefs that seeking help is a sign of weakness

People from marginalized communities may face additional barriers, including lack of culturally competent providers, past experiences of discrimination in healthcare settings, and distrust of mental health systems.

• Do you think there is a stigma associated with mentally ill persons today? Why or why not?
• What are some places in your community that offer mental health services? Would you feel comfortable seeking assistance at one of these facilities? Why or why not?

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