Spotlighting Lived Experience Amid Persistent Gaps in Mental Health Care

World Mental Health Day, observed October 10, focused this year on patient voices. The World Federation for Mental Health set the 2026 theme as "Lived Experiences Heard: Real Voices, Real Change."¹ The observance came as many people still go without treatment. An estimated 14.6 million US adults had a serious mental illness (SMI) in 2024, according to the National Survey on Drug Use and Health, and nearly 3 in 10 received no mental health treatment that year.²

Mental Illness Stigma Still Shapes Perceptions

Stigma remains one barrier. Public conversations often link conditions such as bipolar disorder and schizophrenia with violence. In a 2014 analysis of more than 4400 adults with mental illness enrolled in prior studies, 31% were victims of violence over 6 months, compared with 24% who committed a violent act.³

“Most people with things like bipolar disorder, schizophrenia, and whatnot are very nonviolent,” said Justin T. Ray, PMHNP-BC, a psychiatric nurse practitioner and founder of South Chesapeake Psychiatry and Transforming Minds Interventional Psychiatry in Chesapeake, Virginia. “They deserve compassion and treatment and care, just like everybody else.”

Mental Illness: Missed and Delayed Diagnoses

Stigma also shapes what patients tell their clinicians, Ray said. When asked how often patients hide symptoms, he said, “All the time,” noting that people tend to share more once trust develops. That reluctance can contribute to missed or delayed diagnoses, particularly for bipolar disorder, which affects an estimated 2.8% of US adults in a given year.⁴ A nationwide cohort study in Hungary found an average diagnostic delay of about 6.5 years.⁵

In a 2024 interview with The American Journal of Managed Care^® (AJMC^®), Stephanie Hsia, PharmD, MAEd, BCPP, associate professor of clinical pharmacy at the University of California, San Francisco School of Pharmacy, explained that unipolar depression is the most common misdiagnosis, because patients with bipolar disorder spend much of the year in depressive episodes and often present to primary care during those periods. The cost to patients is huge, she added, as they are started on treatments that do little for their symptoms. She recalled one study that found a 170% increase in costs over 6 years among patients whose bipolar disorder went undiagnosed, compared with those who were diagnosed, and noted that misdiagnosis can also leave patients losing trust in the health care system.⁶

“Maybe you didn't ask the right question. Maybe you missed the answer. Maybe they didn't tell you,” Ray said of why diagnoses are missed. He encourages clinicians to use brief screening tools, such as the Mood Disorder Questionnaire and the Rapid Mood Screener, to identify bipolar disorder sooner.

“If we're not treating them correctly for the disorder that they have, then we can actually make their disease worse,” he said, pointing to disrupted employment, strained relationships, hospitalization, and even death.

Gaps After Mental Health Crisis

Continuity of care remains a challenge, Ray said. People in crisis may get immediate help through a hospital or crisis center, “but then what happens afterwards?” he said. Follow-up appointments can take weeks to months, he added, and housing instability, transportation, and lack of a phone compound the problem.

Patients went out of network 3.5 times more often to see a behavioral health clinician than a medical or surgical clinician, according to a 2024 RTI International study reported by AJMC.⁷ As of 2024, Medicaid did not reimburse adult mental health peer support, a service delivered by people with lived experience in 14 states.⁸

Ray said improving outcomes will require better access, care coordination, and family involvement, since relatives can help clinicians see when “things aren’t going the way that the client says they’re going.”

His message for World Mental Health Day is that mental illness is not a weakness or a character flaw. “It's no different than if you had diabetes,” he said. He added that mental illness is like any other medical problem: “It’s still an illness. It’s still treatable. We can still have recovery.”

References

1. World Mental Health Day 2026: announcing this year's theme. World Federation for Mental Health. August 11, 2026. Accessed October 9, 2026. https://wfmh.global/news/2026.26-08-11_world-mental-health-day-2026
2. SAMHSA releases results from annual survey on drug use and mental health. American Hospital Association. July 28, 2025. Accessed October 9, 2026. https://www.aha.org/news/headline/2025-07-28-samhsa-releases-results-annual-survey-drug-use-and-mental-health
3. Desmarais SL, Van Dorn RA, Johnson KL, Grimm KJ, Douglas KS, Swartz MS. Community violence perpetration and victimization among adults with mental illnesses. Am J Public Health. 2014;104(12):2342-2349. doi:10.2105/AJPH.2013.301680
4. Bipolar disorder. National Institute of Mental Health. Accessed October 9, 2026. https://www.nimh.nih.gov/health/statistics/bipolar-disorder
5. Lublóy Á, Keresztúri JL, Németh A, Mihalicza P. Exploring factors of diagnostic delay for patients with bipolar disorder: a population-based cohort study. BMC Psychiatry. 2020;20(1):75. doi:10.1186/s12888-020-2483-y
6. Joszt L, Lutton L. Misdiagnosis of bipolar disorder and the impact on patient treatment. AJMC. October 17, 2024. https://www.ajmc.com/view/misdiagnosis-of-bipolar-disorder-and-the-impact-on-patient-treatment
7. Grossi G. Study highlights disparities in access to in-network mental health care vs medical care. AJMC. April 17, 2024. https://www.ajmc.com/view/low-reimbursement-rates-for-mental-health-care-linked-with-high-out-of-network-provider-use
8. Bonavitacola J. Policy changes, advocacy are key components in closing gaps in behavioral health. Am J Accountable Care. 2024;12(2):54-56. doi:10.37765/ajac.2024.89574