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Mental Health: The Big Elephant in the Room

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Over the past 50 years, mental health has been an area of medicine often stigmatized and surrounded with controversy. Mental health disorders are a leading cause for disability worldwide.

Many associate the term mental health with mental hospitals, involuntary medical treatment, and drugs. It is no surprise that such a term has a negative connotation, given some of the infamous "innovations" that have been recorded in its history, such as lobotomies, electro-convulsive therapy, and others. However, it is safe to say that the days of "institutionalization" and definition of mental health issues as pure biological anomalies are, for the most part, behind us now.

Two important distinctions must be made with respect to mental health: First, there are two primary types of cases -- those that are severe and persistently ill, and those that are of common mental health "disorders" (e.g., depression, anxiety). Second is that there are professionals whose philosophy is disease-focused vs. personal development-focused -- in other words, treating symptoms vs. treating the person as a whole.

One of the more modern interpretations of mental health issues is that they are no different than other medical conditions like HIV or cancer, which are prevalent yet not fully understood. Some of these disorders, simply put, are situations that we do not understand but need to explore and cope with.

Recent statistics from the Centers for Disease Control reveal some interesting facts about mental health:

  • Yearly national expenditures in mental health surpass $112 billion.
  • Every year, approximately 67.4 million people have ambulatory care visits (to physician offices, hospital outpatient and emergency departments) with mental disorders as primary diagnosis.
  • More than 60 percent of nursing home residents have mental health disorders.
  • "Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005-2008 and the most frequently used by persons aged 18-44 years."
  • Women are 2.5 times more likely than men to take antidepressants.
  • "Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year."

Given these numbers, we should ask ourselves: Why is the use of antidepressant medication skyrocketing? Why are mental health expenditures on the rise? What could be the impact of health care policy changes? Is the legalization of controlled substances going to help?

In my pursuit for answers to these questions, I spoke with Melissa Cramer, LCSW, CAP, a licensed psychotherapist and certified addictions professional from Grow Heal Love, and R. John Repique RN, MS, NEA-BC, vice president of Jackson Mental Health Hospital in Miami.

The Rise in Antidepressant Use and Medicalization of Mental Health

As with the increase in national mental health expenditures, antidepressant use is on the rise. Even though they do serve a purpose in the recovery from mental health disorders, the consumerization of health care, especially pharmaceuticals, has provided the perfect opportunity for drug manufacturers to make money, as well as giving the perception of an "easy out" for patients. In addition, sometimes it is easier for mental health professionals to do several 15-minute medication management sessions and keep the patient stabilized, to maximize throughput, especially in overcrowded facilities. All of this ensures continued demand for pharmaceuticals.

Gender and Ethnic Disparities

Most notably, women are more likely to consume antidepressants. In addition, women are more likely to seek treatment from mental health professionals. Professionals agree that because of gender roles and socialization, women tend to internalize their struggles more than men, whereas men are more likely to "act out" their struggles --emotions vs. behavior. In other words, it is "okay" for women to be treated for mental health disorders.

Conversely, Hispanics and other minorities are less likely to seek treatment for mental health disorders, given cultural beliefs and values. As such, some mental health facilities, like Jackson in Miami, have created programs to provide culturally-sensitive services.

Impact of Health Care Reform and Reduced Funding

This is a usual topic of concern nowadays for any health care professional, but in mental health, it's even more concerning. Reduced funding for mental health would mean that more people are left untreated, which often results in some type of law-enforcement action -- not because of ill will, but rather because of the person's condition. With respect to the integration of mental health to other areas of medicine, as desired by the accountable care model, experts agree that it lags behind its counterparts.

The Role of Mental Hospitals and the Criminalization of Mental Illness

Despite deinstitutionalization, experts believe that mental health hospitals and facilities will continue to exist, although more focused toward acute care rather than chronic, the latter shifting toward community-based care. Involuntary commitment will still be necessary to stabilize patients that pose danger to themselves or others.

It is important to note that without the existence of these facilities, and because of the criminalization of mental health disorders, some patients would end up incarcerated, which does not lead to their recovery.

The NAMI Policy Research Institute claims that prisoners with mental illness cost the nation an average of nearly $9 billion a year, and that 25-40 percent of people with mental illness at some point end up passing through the criminal system. They also reported that 19 out of 31 states responding to a survey reported a disproportionate increase in prisoners with mental illness in the past five years.

Legalization of Controlled Substances

Even though this topic is mostly driven by people's personal beliefs, from within the health care community, it still remains unknown what the impact would be. Some believe that eliminating the stigma for controlled substances would remove one of the factors that turn it into an addition -- the thrill of obtaining the substance itself. However, others believe that because substance abuse often causes psychotic episodes, we would see an increase in medical intervention.

In any case, the legalization of controlled substances is still a solution to the consequence of a major problem, the problem being that people are not attending to their emotional problems and are discouraged from seeking help by social stigma. Lack of emotional intelligence, an increasingly isolating environment in today's world, dispassion for others and their problems, and lack of community is all part of the problem.

Conclusions

Mental health is an important area of medicine that, despite its history, is evolving in order to become less stigmatized by the public and other health care professionals. Experts believe that mental health issues should be no different than other chronic conditions, and as such should receive the same level of importance.

Medication will always be dominated by special interests, regardless of whether it's for mental health or for another illness. There will always be people more susceptive to mental health disorders than others, and as research continues on the human genome, so will treatment, and potentially prevention.

With respect to substance abuse and mental health, the Substance Abuse and Mental Health Services Administration (SAMHSA) is working toward a recovery-oriented model of treatment, "a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential."

What still remains unclear is the path toward the decriminalization of mental illness, and to what extent will the issue of the mentally ill in jail will shape future health care policy.

We must all learn to attend to our emotional problems before they potentially develop into mental illnesses.

I hope you all have enjoyed reading this post, and please express your opinions in the comments section below.

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