It's estimated that more than one-fifth of adults in the United States have a mental health condition. But each year, over a third of adults with severe psychiatric disorders are misdiagnosed. Women and people of color are even more likely to be misdiagnosed in the medical field overall.
Lizzy McGrevy, Side Effects Public Media’s community engagement specialist, spoke with Health Reporter Elizabeth Gabriel to answer one question: Why is it so difficult to diagnose mental health conditions?
This transcript has been edited for length, style and clarity.
McGrevy: Learning and behavior disorders are supposed to be caught in elementary school, right? So why are [some] people not getting diagnosed until they’re full grown adult?
Gabriel: It’s normal for young people to be scared of things or get sad and anxious sometimes — these things may not need treatment and will pass. But parents and teachers are not trained to recognize when these may point towards a mental illness.
“How in the world would we expect parents to know how to diagnose things, or teachers to know how to diagnose things like this? They're not trained to do that,” said Leslie Hulvershorn, the chair of Indiana University’s psychiatry department. “So you have to come in contact with a trained mental health clinician, and I mean, most people just never come into contact with someone to get a psychiatric assessment.”
So, a parent would have to seek out psychiatric help if they have concerns. Even if they want to do that, finances can be a barrier. Plus there’s still a shortage of psychiatrists, which means it might be a while before someone is actually seen. That’s why 1 in 7 kids who have at least one mental health condition don’t receive treatment.
McGrevy: So then there’s this idea of how we define specific mental health issues versus normal behavioral problems. For example, I hear all the time that if someone is hyperactive then they definitely have ADHD. Especially when we’re talking about boys.
Gabriel: Fun fact, that’s actually just a stereotype. For example, if a boy is more hyperactive and runs around a classroom, they may or may not have attention-deficit/hyperactivity disorder or ADHD. And symptoms for things like ADHD can present differently in different people. So, just because someone doesn’t have more noticeable symptoms of hyperactivity, doesn’t mean they’re not there. That just means they’re able to mask or hide them better.
McGrevy: Well, that makes a lot of sense. I’ve also heard of some people being diagnosed with one thing, then years and years later, they’re diagnosed with something else. It sounds like maybe there’s a lack of innovative technology in play here, is that correct?
Gabriel: You're right on the money, Lizzy! Scientific advancements in mental health aren’t far enough to where we can diagnose mental health conditions using technology like MRI (magnetic resonance imaging) scans. Medical providers know that certain amino acids and fat cells create gene codes in the brain when someone has a mental health condition. But there isn’t technology that can say, ‘Hey, if [you are] X percent different from someone with a baseline of certain gene codes, then you definitely have depression.’
On top of that, a lot of mental health conditions have overlapping symptoms. So, if you compare ADHD and obsessive compulsive disorder, or OCD, they can both show signs of difficulties concentrating and sleep disturbances, but they can have different treatments.
It can be easier to diagnose someone if they’re having one of the more severe mental illnesses that come with symptoms like hallucinations or delusions.
McGrevy: So, what needs to happen so that it's easier to diagnose these mental health conditions?
Gabriel: Like many problems in the world, this also circles back to money and resources. Hulvershorn at Indiana University also said it takes a lot of patients — hundreds of thousands if not millions — for researchers to be able to study mental illness. Without that, it’s harder to develop future technologies to diagnose mental illness by, say, looking at a scan or a diagnostic test result.
And every disorder is different. For example, bipolar depression is different from major depression. Only around 1 to 2% of the population has some of these mental illnesses like schizophrenia and bipolar disorder. So, even though it’s a lot of people, it just makes it more complex to carry out these studies.
McGrevy: Elizabeth, thank you so much for this great information.
If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.
Contact WFYI’s health reporter Elizabeth Gabriel at egabriel@wfyi.org.
Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.
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