On March 11, 2009, the National Alliance on Mental Illness (NAMI), the nation's largest mental health citizen advocacy group with more than 1100 state and local affiliates across the United States, released Grading the States: 2009, a report card on the state of public mental health services for adults with serious mental illnesses. The report compared 10 characteristics of "a life-saving, cost-effective, evidence-based mental health care system" across states.
The national grade this year was a "D," an indicator that no progress has been made since the same group's baseline report issued in 2006, and NAMI warned that state budget crises might lead to further declines. Overall, the grade distribution for 2009 included six Bs, eighteen Cs, twenty-one Ds and six Fs: a national disgrace. If one of your kids came home from school with a report card like that, you would ground him immediately.
Most Americans don't fully understand the toll that these disorders take on families and their loved ones until it hits home---either directly or when a close friend, neighbor or colleague is grappling with a mental disorder. Depending on the situation, either it happens suddenly or there's downward spiral: A teenage daughter, the valedictorian of her high school, calls home from college one night overcome by irrational fears; she believes that people in her dorm are following her and reading her mind. Or a son is unable to complete his final year of high school because he is unable to get out of bed each morning, profoundly depressed and unable to shut out the disturbing voices in his head. Or a spouse, with an excess of energy is unable to concentrate at work because he hasn't slept for days, his mind preoccupied with racing thoughts.
According to the National Institute of Mental Health (NIMH), serious mental illnesses, like schizophrenia, bipolar disorder, and severe depression, affect about 6 percent, or 1 in 17 individuals. Mental disorders are the leading cause of disability in the U.S. and Canada for people between the ages of 15 and 44. Yet because of stigma and shame, these no-fault brain disorders remain shrouded in myths and misinformation. As a result, people with these disorders remain undiagnosed and untreated, winding up in far more costly and inappropriate settings such as jails and prisons, hospital emergency rooms, homeless shelters, or on the streets.
These illnesses were once considered grim--and even hopeless--as late as the early part of the last century. But with advances in treatment and research, mental health professionals now recognize that these disorders are often chronic, but eminently manageable conditions, like heart disease, diabetes, and asthma. Sometimes, symptoms remit completely with early recognition and treatment; in other situations, there may be cycles of relapse and recovery but individuals can indeed look forward to a life well-lived.
In the same way that people with physical disabilities are empowered when they have equal access (for example, a person in a wheelchair who uses a ramp to mount a curb or uses an elevator to catch a train to work), people with mental illnesses may require accommodations to achieve the promise of recovery. The recent signing of federal mental health parity legislation (the Mental Health Parity and Addiction Equity Act of 2008) was an important step in improving access to mental health treatment but there are still gaping holes in basic services, treatment programs, and supports in most communities. Another daunting problem is the lack of information, understanding, and compassion among the general public. This report represents an important step in engaging legislators, public officials, the media and ordinary citizens in a continuing dialogue about serious mental illnesses.
In a press release distributed with the report, NAMI Executive Director Michael J. Fitzpatrick states, "There is an urgent need to move forward with proven, cost-effective, mental health care practices. But the states are cutting budgets. The costs of untreated mental illness end up being shifted elsewhere. Governors and state legislatures need to invest instead in progress. The question is whether they have the political will to do what's right."
Linda Rosenberg, MSW, President and CEO of the National Council for Community Behavioral Healthcare praised the report, stating that its findings confirmed what the National Council is hearing from centers around the country that treat people with mental illnesses. "Treatment center after treatment center is experiencing increased demand and has fewer resources to meet the need," says Rosenberg. Clearly, years of federal and state neglect coupled with the economic downturn have caught up with us."
Click here to find out the grade for your own state.
Irene S. Levine, PhD blogs about friendship regularly for HuffPo. Trained as a psychologist, she is a research professor of psychiatry at the New York University School of Mental Health. She and her husband, Jerome Levine, MD, also a professor of psychiatry at NYU, recently co-authored Schizophrenia for Dummies (Wiley, 2008).
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