The World Health Organization defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”
By definition, good mental health is integral to our ability to survive and thrive, as individuals and as a city. However, health professionals haven’t always held this view. In fact, the move towards a more sensitive, holistic understanding of mental illness is relatively recent.
Historically, mental illness was viewed by many cultures as a form of punishment for sins, a flaw in the family bloodline, or as an aggressive and untreatable illness. As a result, the history of how we have handled mental illness is pretty horrific and includes asylums, exorcisms, lobotomies, and isolation. Over time, these extremes gave way to more progressive ideas about treating mental illness. Archaic treatment procedures lessened and scientific study, medicines, campaigns, and public education efforts ushered in more sensitive treatment approaches.
We have come a long way, but we still view and treat mental illness separately from physical illness and health despite clear evidence they are related. There is still tremendous stigma associated with mental illness, and as a result, there is great reluctance to address the issue openly. In New York City we know that one in five adults experience a mental health disorder in any given year. Among our youth, 8 percent of New York City public high school students report attempting suicide, and 73,000 report feeling sad or hopeless each month. In addition, consequences of substance misuse are among the leading causes of premature death in every neighborhood in New York City.
And New York City is not alone. According to the World Health Organization, mental illness results in more disability in developed countries than any other group of illnesses, including cancer and heart disease. The Center for Disease Control estimates that 25 percent of all U.S. adults have a mental illness and that nearly 50 percent will develop at least one mental illness during their lifetime. Despite these statistics, in the U.S. it has only been since 2010 that mental health and substance abuse treatment have been included as an “essential benefit” that all private insurers and Medicaid have to cover. Unfortunately, the current American Health Care Act that just passed the House and is now in the Senate would make this requirement optional. This would be disastrous and a major setback to the progress we have made.
In January 2015, the City of New York announced a major commitment to mental health and the creation of a mental health system that would serve all New Yorkers. By taking a population health approach to mental illness, the Mayor’s Office and the Department of Health and Mental Hygiene unveiled Thrive NYC, A Roadmap for Mental Health for All and backed it up by committing over 850 million dollars in City funding. The First Lady, Chirlane McCray, has made the initiative her highest priority issue and become a champion for the mentally ill by speaking out about her personal experiences in order to reduce stigma and advocating for reforms to the system.
Thrive NYC Roadmap to Mental Health for All is a plan for completely overhauling the mental health system in NYC. The report or Roadmap is a multi-year program for doing this and includes 54 targeted initiatives guided by six principles: Change the Culture, Act Early, Close Treatment Gaps, Partner with Communities, Use Data Better, and Strengthen Government’s Ability to Lead. A year later, there is much progress to report including: the successful launch of a destigmatizing ad campaign; diversion programs that help people with mental illness receive treatment instead of being sent to jail and; mental health counselors in schools. The early success of this work is undoubtedly tied to its comprehensiveness.
As we approach the end of Mental Health Month, let’s reflect on these achievements. We are shifting the culture of mental health. It is no longer acceptable for mental health work to operate in a silo hidden away from other important health initiatives. Mental health is public health. It must be included as part of our goals for individual and collective health.