(June 26, 2014) Six months after implementing the Affordable Care Act in Pennsylvania, mental health professionals say they have not seen greater use of mental health care in their region (“ACA hasn’t boosted use of mental-health care services in Philly region,” Kaiser Health News, June 24).

People aren’t accessing treatment because “there is still a lot of stigma [attached to mental illness],” says Patricia Kleven, director of outpatient mental health services at the Belmont Center for Comprehensive Treatment.

Actually, “the main issue is the Medicaid gap,” said Joseph Rogers, chief advocacy officer for the Mental Health Association of Southeastern Pennsylvania. "If you don't have private insurance and you are not poor enough to be on Medicaid, it is very difficult to get behavioral-health services."

But perhaps it isn’t just stigma or the Medicaid gap that are preventing people from using services. Even though the Affordable Care Act has significantly increased insurance coverage for mental health care, it won’t help the people who need treatment the most.

These are the people who suffer from a condition called anosognosia, an anatomical brain condition that affects approximately 50% of individuals with schizophrenia and 40% of individuals with bipolar disorder. People with anosognosia are simply unable to recognize their own illness – no matter how painfully obvious it may be to everyone around them. They are the people sleeping on the front steps of a community clinic, but who will not walk inside to seek treatment.

If we really want to address the most vulnerable people we need to foster universal adoption of mental illness treatment laws based on a person’s need for treatment and provide sufficient public psychiatric beds to treat individuals in psychiatric crisis.