SINOUÉ

Never like today, in the United States, as in many places around the world, have psychiatric treatments and therapies been as effective on mental disorders as they are today. However, according to the Department of Health and Human Service (equivalent to a secretary of state for health) half of the 20% of the American population who receive these treatments still do not benefit from them.
 
 The causes cited as being responsible for the lack of efficiency of the American system in the care of people requiring psychiatric support are twofold : 
 

• The American care system is notoriously disorganised, and is complex due to the mixing of federal and state levels (with a lack of coordination as the main consequence).

• The American care system does not take sufficient account of the stigma attached to mental illness in the general population.

The American health system seems to lack a willingness to organize globally with the objective of harmonizing the supply of care at the national level. It is a de facto mental health system, with no real political will to organise and harmonise at the federal level.   
The country thus has a wide range of treatments and services equitably distributed geographically, but also between public and private services. The main consequence of this lack of political will to organize at the national level is a lack of efficiency and the failure to address many issues. 
Yet each year, it is estimated that 15% of all adults and 21% of American children and adolescents use this system. Generally, it is described as consisting of four major components.

The inefficiency of the U.S. mental health system is also due to its complexity. In order to achieve better performance, and care for more patients waiting or seeking care, greater coordination across the many sectors (specialised public-private, general care, social care, welfare, housing, justice, education) is needed.
Without their coordination, the supply of care in the United States is likely to remain largely fragmented and a barrier to access. Adding to the complexity of this system is its dependence on numerous sources of funding, with mutually competing incentives.
The public and private parts of the “de facto” U.S. mental health system deal with distinct but partly overlapping populations. 11% of the U.S. population uses the specialised or generalist system for mental health care each year, and 10%, or almost all users, consulted privately, and 2% consulted publicly. Finally, about 1% of the population uses hospitals, a third of which are in the public sector, suggesting that those who need the most intensive care rely more heavily on the safety net of the public system.
The lack of coordination between private and public players thus makes it impossible to effectively monitor patients, their progress and their care pathway. 
The organisation and structuring of a real mental health system in the United States is thus undoubtedly a public health issue for American society.