Psychological Medicine

Research Article

Correlates of unmet need for mental health services by children and adolescents

A. J. FLISHER a1 , R. A. KRAMER a1 , R. C. GROSSER a1 , M. ALEGRIA a1 , H. R. BIRD a1 , K. H. BOURDON a1 , S. H. GOODMAN a1 , S. GREENWALD a1 , S. M. HORWITZ a1 , R. E. MOORE a1 , W. E. NARROW a1 and C. W. HOVEN a1
a1 From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico


Background. Little is known about the extent and correlates of unmet need for mental health services in community samples of children and adolescents.

Methods. Data were obtained from the 1285 parent/youth pairs interviewed at four sites in the USA and Puerto Rico in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Unmet need was defined to exist if psychopathology and associated functional impairment were present but no mental health services had been received in the previous 6 months.

Results. Of the total sample, 17·1% had unmet need. Adjusting for demographic variables, logistic regression analyses revealed that unmet need was significantly associated with: indicators of economic disadvantage, such as being on public assistance and not being covered by health insurance; opinions of the parents and children or adolescents that the latter had poor mental health; parental psychopathology; poor school grades; and parent-reported access barriers such as concern that the child would want to solve the problem unassisted, would refuse to attend mental health services, or would be hospitalized or taken away against the parent's will. No youth-reported access barriers were significantly associated with unmet need.

Conclusions. The economic correlates of unmet need may attain increased importance in the light of current reform in health care financing in the USA. Access may be facilitated by increasing parental knowledge of mental health services and enabling children and adolescents to initiate contact with services independently of their families.


Address for correspondence: Dr Alan J. Flisher, Department of Psychiatry, University of Cape Town, J5 Groote Schuur Hospital, Observatory 7925, Republic of South Africa.