Unmet need for chronic mental ill health: A population-based record linkage study

INTRODUCTION: Many people with chronic mental ill health do not receive the treatment they require, though the true extent of the associated socio-demographic and socio-economic factors is unknown. OBJECTIVES: This unique record linkage study quantifies the characteristics of those reporting chronic poor mental health and the likelihood of being in receipt of pharmacological treatment for those who report chronic mental ill health. METHODS: The Northern Ireland Longitudinal Study (NILS), a random 28% of the 2011 Census returns (aged 25-74), was linked to a population-wide electronic database of prescribed medications. All cohort attributes, including presence of chronic poor mental health were derived from the Census. Logistic regression was used to test the likelihood of people with poor mental health being prescribed psychotropic medication. These findings were compared against similarly derived characteristics of those with respiratory illness on treatment. RESULTS: Overall, 23,803 (8.3%) of the enumerated 286,717 reported poor mental health and, while 81.5% received pharmacological treatment, those of non-white background (OR=0.38: 95%CI=0.26-0.54), never married (OR=0.67: 95%CI=061-0.73), unemployed (OR=0.65: 95%CI=0.53-0.81) or living in a rural area (OR=0.88: 95%CI=0.79-0.98) were less likely than their respective peers to receive medication for poor mental health. Non-treatment of respiratory illness was less socially patterned. CONCLUSIONS: Some but not all of the observed variation in receipt of psychotropic medicines may represent unmet need. Further studies are required to clarify the patterning of and possible reasons for underuse, including understanding of and attitudes towards healthcare services of groups who are identified as being less likely to receive treatment (for example ethnic minorities and unemployed). HIGHLIGHTS: Self-reported chronic mental ill health varied by socio-demographic and socio-economic characteristics. Although a high proportion of people received psychotropic medication for their mental ill health, there were evident social patterns among those who do not receive treatment. Ethnic minorities, those whose were not married or unemployed were considerably more likely to experience unmet need.