<\/p>\r\n\r\n[caption id=\"attachment_6599\" align=\"aligncenter\" width=\"731\"] Treatment rates vary by severity of illness and age group:<\/p>\r\n 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\u2014a form of stigma that prevents many from accessing care.<\/p>\r\n 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.<\/p>\r\n 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:<\/p>\r\n 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.<\/p>\r\n<\/section>\r\n In July 2022, the United States launched 988<\/strong>, 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\u2014only about 23% of Americans report being familiar with it (NAMI, 2024).<\/p>\r\n<\/section>\r\n 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.<\/p>\r\n 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.<\/p>\r\n 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.<\/p>\r\n 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).<\/p>\r\n Usually, individuals are hospitalized only if they pose an imminent threat to themselves or others, or are unable to care for their basic needs.<\/p>\r\n 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.<\/p>\r\n 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).<\/p>\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"650\"] 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\u2014compared to about 23% of the general adult population. An estimated 63% of people in jail and 58% in prison have a substance use disorder.<\/p>\r\n This situation has led some to describe jails and prisons as \"the new asylums.\" The largest county jails\u2014Los Angeles County Jail, Chicago's Cook County Jail, and New York's Rikers Island\u2014each hold more people with mental illness than any remaining psychiatric hospital (Treatment Advocacy Center, 2024).<\/p>\r\n Recognizing these challenges, many communities have developed alternatives:<\/p>\r\n For individuals who need ongoing support but not hospitalization, several options exist:<\/p>\r\n These options can provide individuals with a sense of community while allowing them to live more independently than in institutional settings.<\/p>\r\n Most people with mental illness are not hospitalized but receive treatment in outpatient settings. People enter treatment through various pathways:<\/p>\r\n Involuntary treatment<\/strong> refers to therapy that is not the individual\u2019s choice; if an individual is mandated to attend therapy, they are seeking services involuntarily.<\/p>\r\n Voluntary treatment<\/strong> means the person chooses to attend therapy to obtain relief from symptoms.<\/p>\r\n<\/section>\r\n<\/section>\r\n Mental health treatment occurs in diverse settings:<\/p>\r\n Multiple types of professionals provide mental health services, including:<\/p>\r\n Licensing requirements vary by state, and scope of practice differs among provider types.<\/p>\r\n The United States faces a significant shortage of mental health professionals. As of 2023, approximately 169 million Americans\u2014more than half the population\u2014live in Mental Health Professional Shortage Areas. Over 8,000 additional providers would be needed to meet current demand (Commonwealth Fund, 2023).<\/p>\r\n 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.<\/p>\r\n The cost of mental health care remains a significant barrier for many people. However, the Mental Health Parity and Addiction Equity Act of 2008<\/strong> 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.<\/p>\r\n 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.<\/p>\r\n Perhaps the most pervasive barrier is stigma\u2014the 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:<\/p>\r\n 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.<\/p>\r\n According to the 2024 National Survey on Drug Use and Health (NSDUH):<\/p>\n![\"A](\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2016\/11\/11024233\/af00b24d262b28c472bd5266e6f18837f30f39cf.jpeg\")
Figure 1<\/strong>. About one-third to one-half of U.S. adolescents (ages 8\u201315) with mental disorders receive treatment, with behavior-related disorders more likely to be treated.[\/caption]\r\n\r\nTreatment Rates<\/h3>\r\n
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Disparities in Treatment Access<\/h3>\r\n
Treatment Today<\/h2>\r\n
Community-Based Care<\/h3>\r\n
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The 988 Suicide and Crisis Lifeline<\/h3>\r\n
Telehealth Expansion<\/h3>\r\n
Psychiatric Hospitalization<\/h2>\r\n
Inpatient Care Today<\/h3>\r\n
![\"Photograph](\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225139\/CNX_Psych_16_01_Homeless.jpg\")
Figure 2<\/strong>. (a) Of the homeless individuals in U.S. shelters, about one-quarter have a severe mental illness (HUD, 2011). (b) Correctional institutions also report a high number of individuals living with mental illness. (credit a: modification of work by C.G.P. Grey; credit b: modification of work by Bart Everson)[\/caption]\r\n\r\nMental Illness in the Criminal Justice System<\/h3>\r\n
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Residential Options<\/h3>\r\n
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Routes to Treatment<\/h2>\r\n
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involuntary and voluntary treatment<\/h3>\r\n
Treatment Settings and Providers<\/h2>\r\n
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\r\n\t
Barriers to Treatment<\/h2>\r\n
The Workforce Shortage<\/h3>\r\n
Financial Barriers<\/h3>\r\n
Stigma<\/h3>\r\n
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Mental Illness and Treatment by the Numbers<\/h2>\n