Psychiatrists' first large-scale assessment of the general population shows nearly 30 percent need mental health care and about one-third of them get it.

The study focused on Baltimore, where a team of psychiatrists interviewed 816 people between 1993 and 1999.

They found the greatest need was treatment of alcohol dependence, nearly 14 percent, and major depression, nearly 11 percent.

"There are a lot of people who need psychiatric care who aren't getting any," says Dr. Erick Messias, psychiatrist at the Medical College of Georgia and lead author on the study in the March issue of Psychiatric Services. "There is a constellation of factors keeping people away from that care. This translates into people suffering for years, when there is a solution."

He notes that many people don't even seek help, some because they believe they'll get better on their own. A perceived lack of efficacy of treatment, societal pressures, stigma and a lack of comprehensive insurance coverage for mental health also are factors. Insufficient numbers of mental health professionals also impede access.

In his own practice, Dr. Messias sees people who have struggled for years before they finally seek help. While he acknowledges that seeking help won't always cure the problem, he believes it can decrease most people's pain.

The study looked at the most common mental health problems, social phobia, panic disorder and agoraphobia - in addition to depression and alcohol dependence. These problems may not require medication but could benefit from treatment, from psychotherapy to programs such as Alcoholics Anonymous, he says.

Interestingly those with severe mental illness, such as schizophrenia, are more likely to get help. "However, from a public health perspective these conditions, albeit causing great pain and suffering, compared to prevalent mental disorders, affect a smaller proportion of the population" Dr. Messias says.

"Prevalence of mental disorders is only an approximation of the need for treatment," he and co-authors write. "There is a substantial need for mental health services in the general population."

Dr. Messias suggests that Baltimore's population reflects the prevalence and unmet needs of most larger cities, such as New York, Chicago and Atlanta. Studies are needed to see how midsize and small cities fare, he says.

What is clear is more mental health professionals are needed across the spectrum, including psychiatrists, psychologists, social workers and occupational therapists, and those professionals need to work as teams to maximize impact, he says.

He estimates that within his own practice, a psychologist working with him would enable him to double his patient load.

Acknowledging that it can be difficult for individuals to decide they need any level of mental health care, Dr. Messias says there are some key indicators. "I always ask patients how they sleep, because the way you sleep tells me a lot about how well you are," he says. "If you are so tired you are sleeping all the time or you can't sleep, that's a sign that something on your mind is not letting you relax." Work and personal relationships are two other good indicators. "If you can love and work, you probably will do fine."

Researchers at Johns Hopkins University are co-authors on the study which was funded by the National Institute of Mental Health.