Only 14 percent of patients treated for three common mental illnesses receive adequate care in the US

African-Americans and those without insurance coverage for mental health visits are less likely to receive satisfactory mental health care

Only 14 percent of patients treated for three common mental illnesses -- depression, generalized anxiety disorder, and panic disorder -- received care that met with accepted standards, according to a new Harvard Medical School study titled "Recent Care of Common Mental Disorders in the United States" published in this week's Journal of General Internal Medicine.

The study also found that of the individuals who obtained care for any of these three mental illnesses (53.8 percent), African-Americans were significantly less likely to receive adequate care. Compared to whites, African-Americans were only 10 percent as likely to receive care in accordance with accepted guidelines from either general physicians or mental health specialists, adding mental health to the growing list of medical fields with detected racial differences in the quality and form of care delivered.

A key to obtaining mental health coverage that met with guidelines was insurance coverage for mental health visits. Patients lacking such coverage were only 24 to 36 percent as likely as those with coverage to receive adequate care.

Illustrating the significant responsibility primary care physicians have in mental health care, the study showed that more individuals with depression, panic disorder, and generalized anxiety disorder obtained mental health care from general medical physicians (37 percent) rather than from mental health specialists such as psychiatrists (13 percent), or psychologists, social workers and other therapists (19 percent). Care received from mental health specialists, however, was more likely to be adequate (43 percent) than the mental health treatments received from general medicine physicians (28 percent).

Individuals also sought care from non-health care professionals such as clergy (10.4 percent), or through self-help or mutual assistance groups (11.2 percent).

"If you're interested in improving the quality of mental health care, you really have to pay attention to what's happening in primary care, because primary care physicians are increasingly being given the responsibility of caring for people with mental illness," says Philip Wang, M.D., Dr. PH, instructor in medicine, Brigham and Women's Hospital and Harvard Medical School.

Dr. Wang and the study's co-authors, Ronald Kessler, PhD, professor of health care policy, Harvard Medical School, and Patricia Berglund, MBA, Institute for Social Research, University of Michigan, obtained their data from the Midlife Development in the United States (MIDUS) survey, a national telephone and mail survey conducted in 1996. The research was supported by the John D. and Catherine T. MacArthur Foundation.