Logo Image
Opinion|Videos|June 9, 2026 (Updated: June 9, 2026)

From Stigma to System Failures: What's Driving Late Presentations in Mental Health

The panelists highlighted how stigma, misdiagnosis, and the concentration of mental health care in primary care settings collectively contribute to significant delays in patients receiving appropriate psychiatric treatment for MDD, bipolar depression, and schizophrenia.

Episodes in this series

Welcome back to another AJMC Peer Exchange series. In this episode titled, 'From Stigma to System Failures: What's Driving Late Presentations in Mental Health,' Patrick Runnels, MD, MBA, led the conversation about the following questions:

  1. What are the driving factors that lead patients to present later in their disease course? How often do you see this, and why is early diagnosis so important?
  2. How do both social and systemic barriers affect management, outcomes, and overall costs for the patient and healthcare system?

The panelists highlighted how stigma, misdiagnosis, and the concentration of mental health care in primary care settings collectively contribute to significant delays in patients receiving appropriate psychiatric treatment for MDD, bipolar depression, and schizophrenia. The discussion underscored that late presentation is a common occurrence, with many patients having seen multiple providers and undergone incorrect treatment pathways before reaching specialty care. This is a pattern that erodes patient trust and increases treatment resistance over time. The panelists also explored the wide range of social barriers that compound these delays, including affordability, time constraints, and lack of family support, all of which can make it increasingly difficult to treat patients effectively the longer care is deferred.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, 'Provider Shortages and Diagnostic Complexity: The Compounding Challenges of Mental Health Care,' panelists will continue their discussion on major depressive disorder, bipolar depression, and schizophrenia and highlight the cascading impact of provider shortages on care capacity, the diagnostic challenges of differentiating complex mental health disorders, and the clinical consequences of delayed or missed diagnoses.

Related Content