Delays in Treatment for Mental Disorders and Health Insurance Coverage

Wang et al. (2004) present interesting information about the frequent and lengthy delays in receiving treatment experienced by many individuals after the onset of a mental disorder.They estimate a median delay of 10 years after onset until the first contact with a general medical doctor and 11 years until the first contact with a psychiatrist.Even though more severe mental disorders were associated with shorter delays, the average delay between onset and first treatment contact for even the most severe disorders was 5 years.As noted by these authors, there is evidence that delays in treatment can lead to increased morbidity and mortality, including the development of various psychiatric and physical comorbidities and the adoption of lifethreatening and life-altering self-treatments (e.g., licit and illicit substance abuse).Beyond appealing to some sense of obligation or desire to provide adequate and timely medical care to individuals suffering from mental disorders, it is also in the nation's financial self-interest to find out the factors influencing the length of the delay.Wang et al. tested the effect of various individual characteristics, including age, gender, education, and race, on increases or decreases in the length of time before initial contact.Data limitations did not permit them to test for the effect of two other factors likely to be determinants of the timing of contact with a medical professional: income and health insurance coverage.Although education and race are usually correlated with both of these characteristics and therefore may be jointly capturing the effects of income and insurance, the question of the net effect of these two factors remains unanswered.Because affordability of care is one of the few factors private and public policymakers can alter, this is a question worth pursuing.As most people know, mental health care services are not covered by health insurance packages and health plans to the same degree as physical health care services.Not only are there usually more services excluded as covered benefits, but those services that are covered are often subject to higher co-pays and are capped at a maximum number of covered treatments.Less well known is the fact that those with severe mental illness (SMI) are less likely