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John Santopietro, M.D. Headshot

A Message to Remember on the State of Our Union

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James Kirkikis via Getty Images
James Kirkikis via Getty Images

Last night, President Barack Obama delivered his State of The Union address on Capitol Hill. In addressing the nation, he asked the question: Are we going to help or hinder the progress of America? As a psychiatrist, his question evokes a strong response in me because I see how precariously this country is balanced as it relates to behavioral health. Clearly, progress is underway, but I urge communities and leaders to take a bold course of action for correcting a broken mental health system, engaging initiatives that foster early intervention, stigma reduction and, above all, providing access to treatment.

This administration stood strong this past year, moving the issue forward, bringing mental illness "out of the shadows" at a June White House conference, extending mental health coverage through the Affordable Care Act, strengthening Medicaid and ensuring mental health parity. They also committed to expanding mental health treatment for youth and families. The 2014 budget has marked $75 million to create safer school environments and help our schools address pervasive violence and the President asked congress to spend $100 million on mapping the brain. He has been vocal in supporting Mental Health First Aid, a public education initiative that, like CPR, gives the public basic skills in recognizing mental health crises in others so they can reach out to help, instead of turning away or standing by helplessly, erasing stigma through awareness. A year of noteworthy progress in many ways.

At the same time, the stark facts remain. Roughly one in four adults suffers a diagnosable mental disorder. Though adolescence is the period most common for the development of mental illnesses, our fragmented and frayed system does not detect, diagnose and treat until much later in life, as symptoms become more severe -- commonly, and tragically, only after there has been a significant crisis event. Emergency rooms and jails have become the front lines of mental health treatment in the U.S., and the public has been led to believe that mental illness is a prime driver of violence. While an argument can be made that a failed system leaves us all more vulnerable, this could not be further from the truth. In fact only four percent of violent crimes in the United States are associated with mental illness. People with mental disorders are much more likely to be the victim of a violent crime than to commit one. This message and awareness must be consistent if we are to break down stigma and sustain progress.

Addressing our nation's behavioral health challenges requires both healthcare transformation and community engagement. In 1963, President John F. Kennedy passed legislation to shut down asylums in favor of community mental health centers. It was a bold decision. Early interventions, education and seamless access to treatment are what prevent tragedies. Today, decimated mental health budgets challenge states across the country to meet the needs of families and individuals suffering with mental illness; as you examine the current state of our mental health system these pieces are missing. Despite our knowledge of effective and well-proven treatment, there is no funding. This reality results in individuals seeking treatment from facilities unable to assist. In these scenarios, suicide is a far more common tragedy than homicide. Some 38,000 Americans die by suicide each year, as compared to 16,000 deaths by homicide and 39,000 deaths by breast cancer. The reality is sobering.

The State of the Union Address highlights where we have been, but also allows our nation's top leader to shine the light on where we need to go. I am grateful for the dialogue we had as a nation in 2013, but we will all suffer if it does not proceed in 2014. The need for access to quality behavioral health treatment is critical. Let's double down on mental healthcare reform in 2014. Let's invest in integrating behavioral health into primary care and across the entire healthcare continuum to create a seamless safety net. Let's raise our voices one more octave in this most important national dialogue. Let's make this a year of action.