I think the main problem with these things is that most of the time, people are not self aware and they do not want to change.
I’m not saying that is everyone, I know plenty of people with these type of mental illnesses that DID take charge in their life and lead productive lives and finding their zivug without lying and secrets, but many if not most people with these mental illnesses have issues changing and that’s why it’s so hard to treat.
I am speaking pretty generally.
But as we all know nothing stands in the way of will, if one just doesn’t want help or to improve, he won’t.