In Reply: We appreciate Mr. Lee's positive comments on our study. He highlights the importance of adding questions to the assessment battery of the BRFSS that are specifically related to the number of days in which respondents felt totally unable to carry out daily activities. We could not agree more. Like other BRFSS items, additional items on problems with daily living would allow for greater focus on monitoring mental health at the population level. We can no longer continue to plan resources and evaluate the quality of mental health service delivery only at the individual level. Being able to identify geographic, systemic, and sociocultural barriers to high-quality mental health care is paramount to eradicating persistentethnic and racial service disparities.
Having a national data source such as the BRFSS could help identify important shortcomings in the U.S. mental health care system. Community estimates of need could be used as outcome measures to monitor the impact of services, as they reflect the overall mental health status of the population (1). Need estimates by region could help policy makers allocate available resources more efficiently and fairly. Narrow definitions of need fail to provide information that is useful from a community prevention perspective (2,3). Although such definitions capture individual-level cases, they may fail to capture cases that are important to measure in community-level need estimates for monitoring and prevention, rather than for acute care. We do hope that Mr. Lee's suggestion is adopted.
1.Shepard DS, Strickler GK, McAuliffe W, et al: Unmet need for substance abuse treatment of adults in Massachusetts. Administration and Policy in Mental Health Care 32:403–426, 20052.Sareen J, Stein B, Campbell W, et al: The relation between perceived need for mental health treatment, DSM diagnosis, and quality of life: a Canadian population-based survey. Canadian Journal of Psychiatry 50:87–94, 20053.Aoun S, Pennebaker D, Wood C: Assessing population need for mental health care: a review of approaches and predictors. Mental Health Services Research 6:33–46, 2004