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Linda Rosenberg

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A Silent Public Health Crisis

Posted: 09/29/2011 4:06 pm

Americans have heard about a slew of public health crises so far this year. Michelle Obama cited childhood obesity. The FDA warned about tainted food and drugs, while the White House's Office of National Drug Control Policy applied the term to prescription drug abuse. Without a doubt, anyone who saw the movie Contagion would label infectious diseases a pressing public health crisis.

While all of these issues may indeed be legitimate crises, none are as widespread or contribute as much to the burden of illness in the U.S. as do mental illnesses. With October 2-8 being Mental Illness Awareness Week, it's an ideal time to break the silence and stigma that often surround the topic.

The Centers for Disease Control and Prevention (CDC) find that about half of U.S. adults will develop a mental illness during their lifetime. One in four adults experiences a mental disorder in any given year, and one in 17 lives with a serious mental illness like schizophrenia, major depression or bipolar disorder. By 2020, mental and substance use disorders will surpass all physical diseases worldwide as major causes of disability.

Perhaps it is natural that most people associate public health crises with physical illnesses. Yet here again, a CDC report released in September found that cardiovascular disease, diabetes, obesity and other chronic diseases are associated with mental illness. The report found that treatment of the mental illness also can reduce the effect of chronic diseases.

Sadly, almost 40 percent of people with mental and substance use disorders never get treated. Those who seek treatment typically do so after a decade or more of delays, during which time they are likely to develop additional problems. A survey by the Substance Abuse and Mental Health Services Administration found that of the 2.5 million adults with mental and substance use disorders, only slightly more than 11 percent received treatment for both disorders.

The good news is that treatment works. According to the National Advisory Mental Health Council, the treatment success rate for bipolar disorder is a remarkable 80 percent. The recovery rates for other serious mental illnesses follow suit: major depression (65-80 percent), schizophrenia (60 percent) and addiction (70 percent).

Effective mental health and addiction treatments also reduce costs. A Surgeon General's report finds that $1.00 invested in substance use treatment has a return of $7.00 in cost savings on crime and criminal justice costs alone. After all, people in recovery work, pay taxes, buy homes and contribute positively to society. Without adequate treatment, people with mental illness often end up in emergency rooms, homeless or in jail, all of which end up costing taxpayers more money in the long run.

Yet even in a year starting with the tragedy in Tucson and followed six months later by the shooting rampage in Grand Rapids, MI, states continue to make severe budget cuts that threaten mental health services nationwide. In fiscal year 2011, 24 states slashed provider reimbursement rates for Medicaid -- the most important source of funding of public mental health services. The nation's governors have proposed further cuts to Medicaid spending in 2012, even as they predict an increase in people enrolling in mental health services.

Mental Illness Awareness Week is an opportunity to stop the whispering and speak up about mental illness to our friends, co-workers and legislators. We cannot afford to wait for the next national tragedy to recognize that mental illness is a public health crisis that deserves our nation's attention and support.

 
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03:48 PM on 10/05/2011
On my immediate father's side of the family there is schizophrenia, bipolar 2, depression, and substance abuse. My mother had paranoia schizophrenia. I have bipolar, depression, PTSD, and panic disorder. I'm able to get treatment though a program a hospital system has here. Many of my family are not able to get treatment and/or cannot afford the medication.

My Seroquel costs nearly $400 for just a 30 day supply and there is no generic. It's sad that mental illness is still so hush hush in the US. Police officers are not being trained to deal with mental illness and so they use excessive force. Look at the case of the homeless man with schizophrenia who they beat and tasered and later died in the ICU.

No one will believe how common mental illnesses are, even when they run rampant in their family. I hope the attitude towards this topic changes drastically, or we'll pay for it in the long run.
08:20 AM on 10/04/2011
This is #mentalhealth awareness week - what are we doing to shift this publichealth crisis?
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Jim Neal
Candidate US Senate 2008 (D-NC).
06:20 PM on 10/03/2011
Thanks for the post. It's a shame there's not much awareness around and about mental illness. My son is schizo-affective and has been hospitalized for nine months- and still doesn't think there's a thing wrong with himself. He incapable of caring for himself. This is his third hospitalization (fourth actually.) In the wink of a few years, his life became unhinged.

He's 22 years old. Smart, funny and outgoing trapped inside a disease.

Mental illness ranks as the third costliest health care disease in America- tied with cancer. It's a condition for which a grains-worth of knowledge is smothered by a field of the unknown.
11:59 AM on 10/03/2011
If effective treatments are to be developed, researchers must look at etiology -- the cause of the condition -- which may be different for different people. I provide one likely avenue in The Other Side of the Window by Chloe Bierge after years of journalistic medical research.
04:27 PM on 10/02/2011
The crisis not mentioned is that too few individuals in treatment receive that treatment which actually makes a difference. The National Council for Community Behavioral Healthcare noted in its July 5, 2011 press release ".... one-third of people who seek help [for depression] receive minimally adequate care."

Consequently, it is hard to reconcile how Ms. Rosenberg can quote a recovery rate for major depression (65-80 percent) when two thirds of persons receiving care for depression receive care that is not "minimally adequate" according to the organization she leads. [Is Ms. Rosenberg citing the unpublished data included in the National Advisory Mental Health Council's 1993 report? The report was published in The American Journal of Psychiatry; Oct 1993; 150, 10, pg. 1447.]

Mental Illness Awareness Week doesn't justify citing outcomes rarely realized in the community. My peers and I who continue to suffer the agony and consequences of major depression and other mental illnesses deserve better.
05:10 PM on 10/06/2011
When a claim is made as broad as "the treatment success rate for bipolar disorder is a remarkable 80 percent" or the other percentages cited, one wonders how they define the word "success"? Understanding how people respond to medications or therapy isn't as simplistic as quantifying how successful an antibiotic is at curing an infection. In a field as subjective as treating mental illnesses, professional biases may skew the results.

Pollyanna results touted when advocating for more funding or encouraging people to seek treatment should never be assumed to be accurate. Statistics from advocacy organizations, corporations or the government should always be considered with skepticism -- what constituency is really being represented? Remember the old adage about "lies, damned lies, and statistics." The National Council’s objective, no doubt, is to advocate on behalf of their member organizations and their employees, and the use of a few broadly optimistic statistics helps them make their case.

For a more objective analysis of treatment responses, take a look at Robert Whitaker's "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America."
01:25 PM on 09/30/2011
This article drives home America's constant denial on what is a very large national problem that the
politicians continue to "kick the can" down the road. Now, with most of the States having economic
hard times, services for the mentally ill are the first to be cut. The end result: States end up paying
more for these people to be housed in prisons. Another scary silent epidemic is the number of states cutting home health services to seniors. These seniors end up going to more expensive nursing home care. The problem will only grow more expensive if we continue to ignore it.
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12:08 AM on 09/30/2011
1. The price of disclosure is too high; people lose their rights as full citizens the moment they admit they are experiencing mental illness symptoms, including even their ability to drive being questioned.

2. The access to treatment is too limited. Even if one does admit there might be a problem, they are only covered for five or so visits. Nothing can be treated in that time.

3. The cost of treatment is too high. Most people cannot afford therapy and or the medications. Especially since all mental illness medications will no longer be covered in Medicare and Medicaid as of next year.
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Majestry
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01:13 PM on 09/30/2011
I cannot agree more. I have some very serious mental health issues, but I cannot adequately address them because I cannot afford it. I have health insurance, but it is poor and it covers an extremely limited number of visits at a very high copay. I need EXTENSIVE therapy, but I cannot afford $200/hr to work with a therapist, and almost no good therapists take insurance. Some offer a "sliding scale" that will slide to the incredibly reasonable hourly rate of $150. A lifetime of trauma, abuse, and neglect has festered and was never addressed, and I'd probably need to see a therapist for at least 2 or 3 hours a week for months in order to be able to start to address my problems.