Mental illness is a bottomless pit. It is the one area that medical imperialism has failed to colonize. At this time it would be difficult to claim that there is excessive demand; the opposite claim is more plausible. Demand falls far short of need; whether it falls far short of opportunity to benefit from treatment is another matter. Demand falls short in part because of limited insurance coverage for treatment of mental illness. But the main reason is a large gap between the psychotherapists' broad concepts of what is mental disorder that should be treated and the much more limited public concept of mental disorder. There is also a residual stigma attached to seeking help for mental or emotional disorders. It does not fit in the germ model of disease as an external cause.
A further reason for limited demand is that many needing psychotherapeutic help, even viewed from the individual or family members' perspective, refuse to recognize their need and seek help. For those who do seek professional help, the average number of sessions with a psychotherapist is only 2.5, meaning that the vast majority of those who seek help meet at most twice with professional therapists. 1 Fifty percent do not make it to the first agreed-upon meeting. It would be difficult to argue that this is enough to do what can be done for them. Stephen Kopta and associates examined outpatient treatment for sixty-two symptoms and found that the minimum number of weekly sessions needed is eleven and the average is fifty-eight. 2
The implicit collusion between excess supply by providers and excess demand by customers characteristic of medical care is absent in the case of mental illness. Hence the need for a separate chapter.
Twenty five percent of Americans are estimated to experience depression severe enough to require professional help at some time in their lives. 3 The