October 20, 2016; VICE News

More than 20 million Americans with a diagnosable mental health condition did not receive treatment in 2014, according to a new report from the advocacy group, Mental Health America.

The report, “State of Mental Health 2017,” analyzed government data from 2014 and found that of the 44 million Americans with a mental health condition that year—up from 42 million in 2012—over 55 percent did not receive treatment.

Reasons for lack of treatment were both personal and systemic. For individuals with a mental health condition, significant time may pass between onset and the point at which the person recognizes they have a mental health problem. A 2005 study by the National Institute of Mental Health reported the average delay was almost ten years, with social phobias and other disorders sometimes taking twice as long. These delays often lead to a worsening of the condition, resistance to treatment, and lifestyle implications that can include difficulty maintaining relationships, unemployment, homelessness, and substance abuse disorders.

Better screening for mental health issues through easily accessible tools and routine questions from primary care physicians would lead to quicker diagnoses and treatment. While Mental Health America says access to mental health care is improving, it is at a painfully slow rate, with the number of adults receiving treatment in 2014 increasing by only 2.5 percent over 2011 figures.

Systemic barriers to adequate mental health treatment include being uninsured or underinsured, a scarcity of treatment providers and types, and prohibitive costs. While the Affordable Care Act has improved the uninsured rate, over 7.5 million adults with a mental illness still did not have insurance in 2014. Nineteen percent of these adults live in states that have not expanded Medicaid. Almost 23 percent of adults with a mental illness could not seek treatment due to the related costs, including copays for those with insurance.

The United States also faces a serious shortage in its mental health workforce, with only one mental health professional per 1,000 individuals in some states. This figure includes positions such as psychiatrists, psychologists, social workers, counselors, and psychiatric nurses.

Mental Health America’s report also confirmed that people who do not receive treatment for their mental health issues are at increased risk for imprisonment. This was reflected in the figures for Arkansas, Mississippi, and Alabama, which had the lowest access to care and the highest rates of incarceration. In total, 57,000 prisoners in those three states have a mental health condition. (It’s worth noting that neither Mississippi nor Alabama has adopted Medicaid expansion.)

The news is worse for young people with mental health issues. Depression is on the increase, but 80 percent of kids get little or no treatment even when their condition is severe. The National Institute of Mental Health reports that half of all mental illnesses begin by age 14. Without immediate treatment, millions of kids run a higher risk of failing school and teenage pregnancy, among other serious, life-altering consequences.

The United States’ inability to provide consistent, good quality, affordable mental health care to its citizens has repercussions across numerous other social issues including the country’s high rate of incarceration, homelessness, economic inequity, poor physical health outcomes, and increasing rates of substance use disorders. The 2008 federal mental health parity law, that requires insurance plans to cover mental health with benefits on par with medical and surgical benefits, has not been seriously enforced. Rules for commercial insurance plans under the act were not issued by the Department of Health and Human Services until late 2013, taking effect the following July. A lack of transparency on the part of health insurers has made it difficult for government regulators to determine when denial of coverage for mental health treatment has been warranted and under what criteria.—Melinda Crosby