The gap between need and effective treatment for mental health problems continues to be a challenge for researchers and policymakers. Much of the attention has been on differences in treatment rates, with insufficient attention to variation in pathways that people take into treatment. Individuals may choose to seek help but may also be substantially influenced by others or coerced into care. The chances of each type of pathway are influenced by social characteristics and may shape perceptions of effectiveness of care. This paper investigates variation in pathways into care and perceived effectiveness of care. We also examine whether choice or coercion into care are associated with whether individuals perceive care as effective and if severity of illness moderates this relationship. We use data from the 2010–2014 National Survey on Drug Use and Health (N = 10,020). Persons who independently sought mental health care were more likely to rate treatment as effective compared to persons ordered into care. Among people with severe mental illnesses, the probability of rating treatment as effective is lowest among those who were ordered into care. Entry into mental health care is not sufficient for closing the treatment gap if coerced care leads to poorer quality outcomes.

中文翻译：

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心理健康服务的途径和对治疗效果的看法

对精神健康问题的需求与有效治疗之间的差距仍然是研究人员和政策制定者面临的挑战。大多数注意力都集中在治疗率的差异上，而对人们采取的治疗途径的变化却没有引起足够的重视。个人可以选择寻求帮助，但也可能受到他人的重大影响或被迫照料。每种途径的机会都受到社会特征的影响，并可能影响人们对护理有效性的看法。本文调查了护理途径和护理效果的变化。我们还研究了对护理的选择或强制是否与个人是否认为护理有效，以及疾病的严重程度是否减轻了这种关系有关。我们使用2010-2014年全国药物使用和健康调查的数据（N = 10,020）。与被要求护理的人相比，独立寻求精神保健的人更有可能将治疗评为有效。在患有严重精神疾病的人中，将治疗定为有效的可能性在被命令护理的人中最低。如果强迫医疗导致较差的质量结果，则进入精神医疗不足以弥合治疗差距。