Mental Illness Cases Go Untreated

A new study shows that barely a third of Americans with mental illness get proper treatment. And most people with mental illness get their care from primary care physicians. Primary care doctors say they see people who don't want to believe they have a mental illness, and don't want to get treated for one.

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Researchers have found that about half of Americans experience mental problems in their lifetimes, and most people with mental disorders often go untreated or they are poorly treated. That's from a survey out this week. The study explains that of those who did get treatment, about a quarter got care from a general practitioner, so it's in that setting, often a busy doctor's office dealing with all sorts of general medical problems, that many patients first confront their problem. NPR's Joanne Silberner reports on the challenges family practitioners face in trying to deal with mental disorders.

JOANNE SILBERNER reporting:

Family practitioner Michael Klinkman of Ann Arbor, Michigan, sees people with hidden problems every day.

Dr. MICHAEL KLINKMAN (Family Practitioner): Mr. Jones comes in. He's got diabetes. He's got some mild heart disease. He's not working anymore because of those things. And somehow, it all gets through to me that this guy might be depressed. And I say, `You know, let's talk a little bit about how you're feeling.' Well, Mr. Jones came in to get his medications refilled for his other diseases, and he wants to know how well he's doing with his diabetes. He may not be particularly receptive to spend more time talking about things that he didn't think were part of what he was coming in for.

SILBERNER: Klinkman says about half his patients initially reject his diagnosis of depression or other mental disorder. He saw a man just recently who had fatigue, abdominal pain and a history of depression.

Dr. KLINKMAN: We dealt with this abdominal pain and fatigue when I saw him in his previous visits, and it was pretty clear to me, on the basis of that, that this gentleman was having a recurrence of his depression. He was not sleeping well. He wasn't functioning well at work. And the last time I saw him, we explicitly talked about that. I said, `You know, we need to talk about this maybe being depression.' And it took me, all together--it was the last visit of the day. It took me about 45 minutes to chat with him, to help him understand what I was seeing, and to get him to sort of grudgingly agree that he would start back on an anti-depressant medication.

SILBERNER: Klinkman's academic studies at the University of Michigan investigate how primary doctors deal with mental illness. In a study of doctors in Michigan, he found that they did a pretty good job.

Dr. KLINKMAN: Yeah, we did a study of this a few years ago, and from the study that we did, it looked pretty clear that almost all the people that had significant impairing depression in primary care got identified and got treated. And most of those people got better when we followed them up. Of the people that we didn't find from that study, most of those didn't have impairing significant depression. And a lot of those people looked better when we followed up with them even if they weren't identified and treated.

SILBERNER: Still, how much care people with relatively minor depression need is a medical debate that's not likely to be settled soon. For patients with more serious depression, Klinkman says it's tough for a general practitioner to spend enough time with them to do a good job.

Dr. KLINKMAN: We're operating under pretty significant constraints in primary care. We have to see patients every 10 or 15 minutes. Patients have lots of problems. There are lots of treatment guidelines out there. So we're balancing lots of stuff when we see them.

SILBERNER: There are what Klinkman calls financial disincentives in the way insurers pay for mental health care.

Dr. KLINKMAN: It makes more sense for me financially, if I'm being paid in typical ways, to see six or seven people with sore throats in an hour than treat people with depression.

SILBERNER: But many patients want to be treated by their primary care doctors, like Bob, who didn't want us to use his last name. He's a patient of Dr. Klinkman.

BOB (Patient): It would have been a much bigger deal for me if I had to make an appointment at a mental health clinic, go there and start from the beginning with someone like that rather than just seeing the opportunity to talk about it with someone maybe I already knew for a few years, who's been treating me for a lot of other things.

SILBERNER: And even with that, Bob says he delayed going to Dr. Klinkman for a year after his symptoms appeared. Joanne Silberner, NPR News.

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