"Health care reform" is a huge catchphrase in the US right now, causing an endless array of debate as to what the future of American health care will look like. Within the health care debate, improving access to care is one of the main goals. Access to care can be limited by any number of factors, such as geography (you live out in the sticks), time (treatment providers don't have evening/weekend hours), money (you can't pay for your treatment), and also stigma related to seeking care. For mental health issues in particular, stigma can play a large role in discouraging people to seek care. Many people are loath to admit they have a mental health problem. And eating disorders in particular carry the stereotype of being a young, white female's disease. Furthermore, eating disorders are egosyntonic, which means sufferers are not likely to seek care on their own. A recent study from the International Journal of Eating Disorders titled "A Qualitative Study of Perceived Social Barriers to Care for Eating Disorders: Perspectives from Ethnically Diverse Health Care Consumers" examined specifically which factors prevented ED sufferers from seeking care (Becker et al, 2009).
The authors note that
Specifically, respondents perceived that social costs related to acknowledging an eating disorder had influenced them to avoid or postpone treatment or limit their disclosure of related symptoms...Respondents perceived that concerns or symptoms had been unrecognized, misinterpreted, or dismissed because of expectations about the presentation of an eating disorder or social norms relating to weight...Finally, additional impediments to accessing care included economic or health insurance constraints as well as suboptimal availability of specialty services.
Another recent study about barriers to care focused on mental health literacy and treatment-seeking for anxiety disorders, from the journal Depression and Anxiety, and was titled "Barriers to treatment seeking for anxiety disorders: initial data on the role of mental health literacy" (ME Coles and SL Coleman, 2009). Here, the problem was less focused on stigma to seeking care and more focused on a person's ability to recognize and label a set of symptoms as a potential mental health problem.
The statistics were not uplifting. Some disorders (such as OCD and social anxiety disorder) were more easily recognized than other anxiety disorders. From the paper's abstract:
Findings showed that social phobia and obsessive compulsive disorder (OCD) were associated with recognition rates that were generally high and similar to depression ( approximately 80%). In contrast, less than half of the respondents labeled panic disorder or generalized anxiety disorder (GAD) correctly. Symptoms of OCD were attributed to mental illness by approximately 50% of respondents, but such attributions were rare for the other anxiety disorders studied (<12%).
In terms of improving mental health care in the US, we not only need to improve access to care, but also help people recognize what mental health issues may look like, that these issues can affect anyone, and that there is no shame for having a problem and seeking appropriate help.