Two articles that were published in the past week shed light on the public’s perception of mental health and its practitioners. The findings may seem paradoxical at first, but upon closer inspection, they reveal an important story.
Public perceptions of mental health treatment
The first article examines how laypeople view mental health treatments and how they have changed. The authors review 162 surveys conducted worldwide between 2000 and 2015. They explore the public’s perceptions of schizophrenia and depression treatments. The results are surprising.
Firstly, a large majority of respondents to the survey recommended psychologists or psychiatrists as sources of assistance. These specialists were also instructed to treat depression in a similar way as general practitioners but were preferred for schizophrenia. Australia was the exception to this global trend: general practitioners were preferred over mental health professionals in treating depression, and they were equally suitable for treating schizophrenia.
Second, the majority of respondents were in favor of standard mental health treatments. Half of the respondents recommended medication for schizophrenia and two-thirds for depression, while more than three-quarters suggested some talk therapy. Australia was the only country that did not show a preference for psychotherapy.
The authors of the study also examined the changes in treatment recommendations from 1990 to 2011. Both psychiatrists and psychological practitioners were endorsed as providers of treatment at a steadily increasing rate. Public opinion of psychotherapy and medication has also risen, with the latter increasing in popularity by 15 percent each decade.
This suggests that the stigma associated with mental health professionals is not warranted. The public seems to view them and their help positively.
By extension, the public should be more willing to support mental health treatment if they feel it is needed. The mental health of the population should improve as more people seek professional assistance.
Do more treatments lead to improved mental health?
The second article provides some evidence to support this optimistic scenario. However, it then takes a sharp turn. The authors of the article examine whether increased treatment for mental health issues has led to a reduction in their prevalence. The authors compare the developments in the USA with those in the UK, Canada, and Australia.
Mental health treatment rates have risen – sometimes dramatically. The so-called treatment gap is narrowing as a higher percentage of people with mental health issues are receiving help. Antidepressant prescriptions have increased significantly.
The authors use Australia as an illustration and report that government spending on mental health has increased dramatically in real terms. The use of antidepressants more than quadrupled between 1990 and 2002 before almost doubling again in the decade following. In 2009-2010, 46% of those with a mental illness received treatment. This is a dramatic 9% increase in only three years.
It is important to note that a decline in diagnosis does not accompany these increasing rates of treatment. In none of the four countries is there any evidence that mental illnesses are less common or that the average level of psychiatric symptomatology in the population is decreasing. They are either stagnant or slowly increasing.
How can we explain the paradox of mental health treatments without mental health? They dismiss the idea that these treatments don’t work. Many have been proven effective in tightly controlled clinical studies. They offer a few alternatives.
Other factors may mask the positive effects of increased treatment. The increased uptake of mental health treatment may have been offset by the declines in the population’s mental well-being due to increasing levels of adversity and other risk factors. The authors also dismiss this: There is little evidence that life in high-income countries has gotten harder over the past decades.
A growing trend to report mental problems could obscure real improvements in mental well-being. Ironically, mental health in the general public may seem to worsen – or not improve – because stigma surrounding mental health issues is diminishing. Disclosure of psychiatric distress will increase if it is no longer stigmatized.
The “treatment gap” and the “quality gap”
Although the authors of this article do not have much evidence to support their explanation, they still find it plausible. They prefer another explanation. The rising rates of treatment can have disappointing effects for the mental health of the population, not because they are hidden but because it is poorly implemented.
Evidence-based treatment for mental illness is too much. The wrong people are not targeted by too much treatment, and it is delivered in an inadequate manner. Mental health issues are not prevented in the first instance.
Consider the widespread use of antidepressants as an example. The authors of the article claim that these medications are often prescribed for mild cases or people who don’t even deserve a diagnosis when they would be better suited for severe cases. The practice of prescribing is disproportionately targeted at older adults who suffer from relatively low levels of depression. Prescriptions can be too short or are thrown out prematurely.
This research has a clear and urgent message. We must not only close the treatment gap but also ensure that more people are treated. As we’ve seen, a part of the solution is to promote evidence-based psychotherapies, which the public prefers over medication.