Perceived Need for Mental Health Treatment and the Mental Health Response to the COVID-19 Pandemic in the United States

Abstract

Objective: Population-based information on the extent of perceived need for mental health treatment and clinically significant psychological distress can help inform strategies for responding to the mental health impact of the COVID-19 pandemic.

Methods: A representative sample of U.S. adults, age 20 and over (N = 1,957), completed surveys in May and June 2020. Potential target populations were distinguished based on perceived need for mental health treatment and psychological distress, assessed by the Kessler-6, among those without perceived need. Populations were characterized with respect to demographic characteristics and prior mental health treatment history using logistic regression models.

Results: The prevalence of perceived need for mental health treatment was 21%. Perceived need was strongly associated with pre-pandemic treatment history; compared to those with no treatment history, perceived need was dramatically higher among those in treatment when the pandemic began (OR = 53.8 95% CI 28.2–102.8) and those with pre-pandemic treatment history (OR = 9.3, 95% CI 5.1–16.8). Among the 79% who did not perceive need, moderate or greater distress was reported by 19% and was associated with younger age and Hispanic ethnicity (OR = 2.1, 95% CI 1.2–3.6).

Conclusions: In the U.S., where mental health treatment is relatively common, mental health treatment response during the pandemic, and perhaps other crises, should target people with a history of mental health treatment. Outreach to people less likely to seek care on their own despite clinically significant distress should target Hispanic populations.

DISCLOSURE STATEMENT

The authors have not conflicting or competing interests to declare.

DATA AVAILABILITY STATEMENT

All data from the American Life Panel are made publicly accessible one year following data collection. https://www.rand.org/research/data/alp.html

Additional information

Funding

Funding for this research was provided by gifts from RAND supporters and income from operations. Additional funding was provided by a grant from the National Institute on Minority Health and Health Disparities (R01MD010274).

Notes on contributors

Joshua Breslau

Joshua Breslau is a senior behavioral and social scientist at the RAND Corporation whose work focuses on social and cultural influences on psychiatric disorders and their treatment. An anthropologist and epidemiologist with over two decades of research experience, Breslau’s research examines racial/ethnic disparities in risk for psychiatric disorders and treatment use, life course consequences of psychiatric disorders, and impacts of policy on treatment for people with behavioral health conditions. He earned his Ph.D. in anthropology from Harvard University and his Sc.D. in epidemiology from Harvard School of Public Health. Carol North holds The Nancy and Ray L. Hunt Chair in Crisis Psychiatry and is Professor in the Departments of Psychiatry and Emergency Medicine at The University of Texas Southwestern Medical Center in Dallas. She is also Director of the Division of Trauma and Disaster in the Department of Psychiatry. Dr. North completed medical school and residency training in psychiatry at Washington University School of Medicine in St. Louis, Missouri, followed by an NIMH fellowship and a Masters degree, both in psychiatric epidemiology, at the same institution. For more than a quarter of a century, Dr. North has continuously conducted federally funded research into disaster mental health, psychiatric aspects of medical illness, and psychiatric problems of homeless populations, and has developed specialized education programs for professionals, patients, and families, while providing direct patient care and directing clinical services for homeless and seriously psychiatrically ill patients. Melissa L. Finucane is a senior behavioral and social scientist at the RAND Corporation who focuses her research on human dimensions of environmental and health risks. She examines the interplay of affect and cognition and the role of socio-ecological factors in judgment and decision processes under conditions of risk and uncertainty. Dr. Finucane is Director of the Consortium for Resilient Gulf Communities, funded by the Gulf Of Mexico Research Initiative, to assess and address the human impacts of the 2010 Deepwater Horizon oil spill. Dr. Finucane is also a Co-Principal Investigator for two NOAA-funded Regional Integrated Sciences and Assessments (RISA) programs, one in the Pacific Islands region and a second in the Mid-Atlantic region. Dr. Finucane received her PhD in Psychology from the University of Western Australia. Beth Roth is an Associate Director and Senior Research Programmer in the Research Programming Group (RPG) of Information Services (IS) at the RAND Corporation. Ms. Roth has worked on a wide array of research projects, ranging from complex analyses of nationally representative longitudinal surveys to meta-analysis, in all phases of data analysis. She has participated in primary data collection, cleaning, variable construction, and documentation, as well as research design, data analysis, and report presentation. She has designed and managed data collection efforts, organized many databases, and has overseen the programming activities of junior programmers. Rebecca L. Collins is a senior behavioral scientist at the RAND Corporation. Her research examines the determinants and consequences of health risk behavior. She has conducted research on stigma related to mental health conditions and mental health treatment including an National Institute of Mental Health funded study of a social marketing campaign in California. She was a member of the American Psychological Association (APA) task force investigating the sexualization of young girls in the United States. Collins has published a number of studies of adolescent risk, focusing on sex and on substance use in this population, as well as studies of sexual risk behavior in various samples of young adults in the United States. Dr. Collins is a fellow of the Association for Psychological Science, a member of the Society for Personality and Social Psychology, Society for Adolescent Health, and the Society for Self and Identity. Collins has a Ph.D. in social psychology from UCLA.