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  • Print publication year: 2011
  • Online publication date: January 2018

United States of America

from North America
    • By Carol A. Bernstein, MD President, American Psychiatric Association, Associate Professor of Psychiatry, New York University School, Bruce Hershfield, Assistant Professor, Johns Hopkins University School of Medicine, Baltimore, MA, USA, Deborah C. Cohen, Senior Writer, American Psychiatric Association, USA
  • Edited by Hamid Ghodse
  • Publisher: Royal College of Psychiatrists
  • pp 451-456


The USA has the world's largest economy and the highest per capita spending on healthcare, but it lags behind other countries on a number of key health measures. It ranks 23rd in healthy life expectancy and 32nd in infant mortality (World Health Organization, 2009). In 2000, the World Health Organization ranked the US healthcare system as 1st in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations in the study).

Mental health in the USA

Approximately 25% of US adults have a diagnosable mental disorder in a given year and approximately 6% have a serious mental illness. Mental disorders are the leading cause of disability for people aged 15–44 years (National Institute of Mental Health, 2010).

About 11% of adults experience serious psychological distress, such as anxiety and mood disorders, that result in functional impairment that impedes one or more major life activities. Rates of mental illness are highest for adults aged 18–25 years and lowest for those over 50; rates for women are significantly higher than for men. The most common mental illnesses are anxiety and mood disorders (Substance Abuse and Mental Health Services Administration, 2009).

Some 17% of inmates entering jails and prisons have a serious mental illness (which is nearly three times the rate in the general population) (Steadman et al, 2009). As many as 70% of those in the juvenile justice system have a diagnosable mental disorder and one in five has a mental disorder significant enough to impair functioning (Skowyra & Cocozza, 2006).

Unfortunately, the high rate of mental illness does not correlate with adequate treatment. Fewer than half of adults with a diagnosable mental disorder receive treatment in a given year (Kessler et al, 2005). The number of Americans under care for mental illnesses nearly doubled between 1996 and 2006 (from 19 to 36 million) (Agency for Healthcare Research and Quality, 2009). Among those with serious mental illnesses, adults aged over 50 were more likely to use mental health services (71%) than adults aged 18–25 (40%) (Substance Abuse and Mental Health Services Administration, 2009).