Therapy in America 2004
Poll Shows: Mental health treatment goes mainstream

• A surprising number of Americans receive help; report satisfaction with treatment
• More than one-third of those who need treatment do not receive it
• Prescription medication is the predominant type of mental health treatment
• Stigma is down but not out

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Read the Top Line Report (288KB .pdf) Read "Men and Women in therapy" (112KB .pdf)

Washington, D.C.: May 5, 2004 -- More than one in four American adults has received treatment for a mental health problem in the past two years, via talk therapy, medication, or a combination of the two, according to Therapy in America 2004, a new Harris Interactive(R) poll. This groundbreaking survey is the first of its kind to examine consumer trends and attitudes in mental health treatment.

The study was conducted this March using a nationwide phone survey of 501 adults and a follow-up online survey of 1,731 people known to have needed or received treatment. Psychology Today, its online Therapy Directory, and Therapy Directory. "We did not expect to find so many people had taken advantage of the treatment options now available to them, or the extent to which the stigma surrounding the subject appears to have subsided."

Many People Who Need Treatment Are Not Getting It.

While the majority of Americans are familiar with mental health treatment--either through their own experience or that of a family member or friend--a sizable number of those who appear to have needed treatment have not received care. These people are doubtful about the efficacy of treatment, stymied by cost, or concerned about stigma.

• 37% of those who report having experienced sufficient distress to warrant treatment have not received it. These people, an estimated 24 million, represent just over one in 10 people in the general U.S. adult population.
• Among those who have needed mental health treatment but not gotten it, the top reasons given for not receiving it were cost and doubt about its efficacy. 39% report that it is too expensive, 35% say that their problems have not been serious enough to warrant professional attention, 32% do not think treatment would help, and 26% cite concern about lack of insurance coverage.
• Stigma inhibits some respondents from getting needed care: the fear that therapy would go on their "record" is mentioned by 22%, and the concern that friends or family could find out is mentioned by 19%. Such concerns are cited more often by men than by women.
• More than half (52%) of the general adult population believes that it is somewhat or very difficult to access mental health treatment.
• 37% of all insured respondents are unsure of whether their health insurance covers mental health care.

"These survey results confirm what we've suspected all along and validate the direction in which we're moving," says Jerry Vaccaro, M.D., president and CEO of PacifiCare Behavioral Health, a subsidiary of PacifiCare Health Systems that provides behavioral health services to millions of Americans. "We're in the process of developing new programs that identify and reach out to these people so they can get the help they need."

Talk Therapy versus Medication: Understanding the Discrepancy

Numerous studies corroborate the Therapy in America 2004 findings that people who receive medication and those who undergo therapy experience about equal levels of satisfaction and effectiveness. Nonetheless, a great many Americans are being treated with medication alone.

• For those with a treatment history, 81%, or an estimated 48 million people, report taking or having taken a prescription medication for a personal, emotional, or mental health problem in the past two years. In contrast, only 53% report undergoing psychotherapy.
• 25% of American adults who have taken prescription drugs for a mental health problem did not report the level of distress typically associated with those in need of treatment.
• One-quarter of those taking only medication have received a recommendation from a doctor that they receive talk therapy as well, but have not done so.
• Older Americans (ages 50+) are significantly more likely to receive medication alone than are those between the ages of 18 and 49.

"Clearly, medication has made it possible for many more people to seek and receive treatment, especially men who historically might have shied away from therapy," says Dr. Vaccaro. "We know, however, that not all medications work effectively on all people. Talk therapy, particularly goal-focused cognitive therapy, has been shown to be as effective alone or in concert with medication for many patients. Our role as a consumer health organization is to help consumers get the right treatment at the right time."

Consumers Lack Key Information When Choosing a Therapist.

The pragmatic factors that people consider when choosing a therapist, including geographic proximity and cost, fail to address a crucial element of treatment: a good therapist-client match. There is a clear discrepancy between the criteria people use to select their practitioner and the criteria they identify as conducive to successful therapy.

• The most common factors cited in the choice of a mental health professional include: recommendation from a doctor (28%), whether the therapist is part of the individual's health-plan network (26%), proximity to home or work (22%), and cost (17%).
• In contrast, the factors ranked as most important in making therapy successful include: the therapist's listening skills (63%), the therapist's personality (52%), the personal connection with the therapist (45%), the therapist's being active in the session (38%), and the cost (38%).

"When it comes to selecting a therapist--a choice that represents a substantial investment of time and money--people often exercise as little personal preference as they do when hailing a taxi cab," says Jo Colman. "Consumer resources such as Psychology Today's online Therapy Directory can help people identify the therapists who are most appropriate for them."

Conclusions

Therapy in America 2004 is the first study of its kind to examine the emerging trends in mental health care. The clear indications are that an unprecedented number of Americans are seeking talk therapy and medication. Treatment options and access to treatment are expanding and improving to meet consumer need while stigma is diminishing.

The Therapy in America 2004 study suggests that efforts should be made to further facilitate access to treatment, to publicize its effectiveness, and to educate primary care physicians and nurses as well as consumers about the value of talk therapy as well as medication.

About Psychology Today

Psychology Today is the only national consumer magazine devoted to issues of mental health and emotional well-being. The magazine was launched in 1967 and is read by more than two million people. The online Therapy Directory (which can be found at www.psychologytoday.com) provides consumers with a flexible way to search a directory of 20,000 licensed professionals. Therapists identify their areas of expertise, interests, training, and cost per session. Many include personal introductions and photos.

About PacifiCare Behavioral Health

PacifiCare Behavioral Health, Inc. provides mental health, chemical dependency, and employee assistance services to covered members and maintains a national network of behavioral health care practitioners. All PacifiCare Behavioral Health service centers hold three-year, Full Accreditation from the National Committee for Quality Assurance (NCQA), the most comprehensive and rigorous accrediting body for managed behavioral health care organizations. PacifiCare Behavioral Health is a wholly owned subsidiary of PacifiCare Health Systems (NYSE: PHS), with clients including health plans, union trust funds, employers, school districts, and public sector agencies. More information on PacifiCare Behavioral Health can be obtained at www.pbhi.com.

About Harris Interactive(R)

Harris Interactive (www.harrisinteractive.com) is a worldwide market research and consulting firm best known for The Harris Poll(R), and for pioneering the Internet method to conduct scientifically accurate market research. Headquartered in Rochester, New York, Harris Interactive combines proprietary methodologies and technology with expertise in predictive, custom, and strategic research. The company conducts international research from its U.S. offices and through wholly owned subsidiaries--London-based HI Europe (www.hieurope.com), Paris-based Novatris and Tokyo-based Harris Interactive Japan--as well as through the Harris Interactive Global Network of independent market- and opinion-research firms.

To become a member of the Harris Poll Online(SM) and be invited to participate in future online surveys, visit www.harrispollonline.com.

Methodology for Therapy in America Survey

The telephone portion of this project was conducted within the United States between February 16 and March 5, 2004, among a nationwide cross-section of 501 adults. Figures for age, sex, race, education, region, household income, number of adults and number of voice/telephone lines in the household were weighted where necessary to bring the total population of all adults in line with their actual proportions in the population. In theory, one can expect that 95% of surveys with samples of this size would produce results that were within plus or minus four percentage points of what they would be if the entire adult population had been polled using the same methods.

The online portion of this survey was conducted within the United States between February 27 and March 1, 2004, among a nationwide cross-section of 1,731 adults who qualified for the survey on the basis of having needed and/or received mental health treatment within the previous two years, according to the definitions of "need" and "treatment" used in the survey. Figures for age, sex, race, education, region, and household income were weighted where necessary to bring them into line with their actual proportions among those in the general population meeting these same mental health criteria. "Propensity score" weighting was also used to adjust for respondents' propensity to be online. In theory, with probability samples of this size, one could say with 95 percent certainty that the results have a statistical precision of plus or minus three percentage points of what they would be if the entire adult population had been polled with complete accuracy. This online sample is not a probability sample.

Definitions

"Need for treatment" was determined based on responses to the Life Status Questionnaire, an assessment tool used and clinically validated by PacifiCare Behavioral Health, as well as on the respondents' self-perceived need for mental health treatment and having spoken to a primary-care doctor about this at some point within the past two years.

"Therapy" was defined as follows for respondents: "When we use the word 'therapy,' we mean talking to a mental-health professional--such as a psychiatrist, psychologist, social worker, or marriage-and-family therapist--on a regular basis about problems or things that are bothering you. This can be either alone, on a one-on-one basis, or in a group setting."

Copies of the Top Line Findings Report are available upon request. Please contact:
Barbara Kancelbaum, Psychology Today, at 718-788-1408;
Ben Singer, 562-936-1466 and Dagmar King, 714-454-0453 for PacifiCare Behavioral Health, or
Nancy Wong at 585-214-7316 for Harris Interactive.