Why does only one in five Americans with mental illness seek help? Two possible reasons are that people lack information about their mental health benefits and that they expect out-of-pocket costs to be high, according to Michigan State University researchers.

The findings were derived from answers to four questions included in the "State of the State" quarterly telephone survey conducted by the Institute for Public Policy and Social Research at Michigan State University between November 1997 and February 1998. Each survey has a different focus such as crime, government reform, or health policy, as was the case with this survey. The data were published in the article "Knowledge of Mental Health Benefits and Preferences for Type of Providers Among the General Public" in the February Psychiatric Services journal.

Twenty-four percent of the 1,095 randomly sampled Michigan adults responding to the phone survey did not even know whether their health plan included mental health benefits. Of those 65 and older, 34 percent were unsure whether they had mental health benefits, versus 22 percent of those under age 65.

"This suggests that a large portion of the general public—and an alarming percentage of the elderly—may be uninformed about their mental health benefits," explained lead investigator Maureen Mickus, Ph.D., M.S., an assistant professor of psychiatry at Michigan State University. This lack of knowledge may deter the general public from seeking mental health services, she added.

The researchers also studied whether Medicare’s restricted payment for mental health services would discourage Medicare recipients from seeking needed mental health care. Of the 427 Medicare patients who participated in the survey, 57 percent said it would not stop them; however, 23 percent said they would not get help because of cost, and 20 percent said they were unsure.

The second author, Christopher Colenda, M.D., M.P.H., chair of the psychiatry department at Michigan State University and chair of APA’s Council on Aging, commented, "This demonstrates how financial considerations could potentially present access barriers to needed psychiatric services among the elderly." He noted that Medicare recipients have a 50 percent copayment for outpatient psychotherapy services, compared with a 20 percent copayment for general health services.

The study also found that 56 percent of the respondents would seek mental health care from their primary care doctor, but only 13 percent said they would see a psychiatrist. Furthermore, those aged 65 and older were significantly more likely to seek help from a primary care doctor compared with those under age 65.

"Our findings did not explain why most respondents chose to see a primary care physician over a mental health specialist. Perhaps it is to obtain a referral to a mental health professional," hypothesized Mickus. "However, because primary care doctors generally aren’t well trained in detecting and screening mental illness, they may not recognize the patients’ psychiatric symptoms, especially in those patients hesitant to admit they have mental illness."

When asked if she had any recommendations to rectify the underutilization of mental health benefits, Mickus responded, "Public education and outreach are critical to rectify this lack of awareness. This could be done by Medicare employees, CMHC workers, hospital staff, and primary care physicians. For example, there already are various Medicare education offices. Why not have them inform recipients that mental health benefits are covered?"

The study is posted on the Web at <psychservices.psychiatryonline.org/cgi/content/full/51/2/199#T1>.