BOX 2-3Defining Need and Unmet Need for Behavioral Health Services
Defining need for mental health and SUD care has long been a complicated and largely unresolved issue. In practice, various observers and government agencies frequently report the percentage of people with a diagnosable condition (based on epidemiological surveys) who receive treatment as an indicator of need that has been met (see the NSDUH). The implicit assumption is that having a diagnosable condition means needing care. Others have suggested that such measures leave the affected individual’s perception of need unrecognized. Other observers have proposed summing the unique number of people who have a diagnosable condition and the number of people receiving behavioral health care. That approach recognizes the fact that what people view as need may differ from the strict criteria of the Diagnostic and Statistical Manual.
Each year, SAMHSA also reports the number of people who perceived that they had unmet need for mental health care, typically as the percentage of people with a diagnosable condition who perceived unmet need. In 2022, that was reported to be about 26.5 percent. Surprisingly, over half of those reporting unmet need also received mental health services. The implication is that given that about 50 percent of people with a diagnosable condition get treated and 26 percent have unmet need, many of whom received care, there is a significant plurality of people with a diagnosable condition who do not receive treatment and do not perceive unmet need. Further complicating the definitional challenge are data from the Medical Expenditure Panel Survey and NSDUH suggesting that high percentages of people using mental health services have neither a diagnosable mental illness nor significant impairments (Germack et al., 2020; author’s tabulations from the NSDUH).
Perhaps a practical approach to defining need and unmet need is to begin with a focus on combinations of symptoms and impairments on the assumption that someone with a diagnosable condition with impairment would likely need care. Likewise, someone with symptoms of behavioral health conditions that fall below diagnostic thresholds but produce impairments that affect functioning would also qualify as needing care.
