05/15/2011 08:05 pm ET | Updated Jul 16, 2011

The Good News and the Bad News About Mental Health Care in America

Mental illness touches the lives of more than 100 million Americans every year. More than 50 million children and adults in this country are diagnosed every year with mental illness, from common conditions like depression, anxiety disorders (like PTSD, OCD and panic disorder) and drug and alcohol problems to less prevalent but often disabling illnesses like bipolar disorder and schizophrenia. Every one of these people has close family members who are devastated by the diagnosis and overwhelmed by the task of helping them.

People who are physically ill with diabetes, heart disease, asthma and cancer are at far greater risk of becoming depressed. And if you are depressed with these medical conditions, you are twice as likely to develop cardiovascular disease and stroke, four times more likely to die within six months of a heart attack (myocardial infarction) and three times more likely to be non-compliant with your treatment.

For those concerned about health care costs in this country, people with diabetes who are depressed average twice as many visits to their primary care physicians as non-depressed patients, and they have four times the health expenses (which means a lot more time in doctors' offices, emergency rooms and in the hospital). Mental disorders (and heart conditions) are the most costly medical problems in the U.S. In the state of New York, a principal driver of health costs among very high-need Medicaid medical patients is the co-occurrence of mental and addictive disorders (see my Huffington Post blog, "Managing High Need, High Cost Medical Patients").

For employers, depression creates annual indirect costs (absenteeism, lost productivity, disability, etc.) of $84 billion. Moreover, an employee suffering from depression loses 2.2 hours of productivity each day due to mental illness. The odds of missed work due to health problems for employees with depressive symptoms are twice those of employees who do not suffer these symptoms. The World Health Organization has established that depression has been the leading cause of disability worldwide since 1990 and forecasts that by 2020 depression will be second in generating what is termed the "global burden of disease" (which combines years of life lost due to premature death and time lived in states of less than full health).

Mental illnesses, even without their major role in physical illnesses, are highly prevalent: annually, more than one in five people in this country will experience a mental disorder. Remarkably, these conditions can be reliably diagnosed and effectively treated. When mental disorders are not treated, they cause great individual and family suffering, because the pain of mental disorders is no less than that of physical illnesses -- though it can be less visible. Mental agony is worsened by shame, guilt and stigma. The greatest tragedy is suicide, which can appear to be a solution and an escape from unbearable mental pain and hopelessness when in fact it is a permanent "solution" to a temporary problem. Witness the rocketing suicide rate among our veterans.

I have worked with people with mental (and addictive) disorders, and their families, through a 35-year career of taking care of patients and running every imaginable form of mental health service. I see them every day in my capacity as Medical Director of the New York State Office of Mental Health, the largest state mental health system in the country, and communicate with them via my articles as Medical Editor of Mental Health here at The AOL/Huffington Post Media Group. I have spoken with thousands of people affected by mental disorders, and their questions often are: What is happening to me (or my loved one)? Will I ever get well? Whom can I trust? Behind these questions often is the fundamental one: What should I do?

For individuals and their families there is good news and bad news. The good news is that improvement rates for serious mental illnesses like depression and bipolar disorder (also known as manic-depressive illness) rival or surpass those for chronic physical diseases like diabetes and heart disease, provided that the patient receives the right treatment -- consistently. The bad news is that an astonishing 80 percent of people in this country with treatable mental disorders do not have their conditions detected in medical or other settings -- and even when identified and properly diagnosed, they do not receive effective treatment.

There are two main reasons why people don't get what they need:

  1. This country's mental health system is not a system at all but a loosely connected maze of services, both private and public, that too often does not provide the comprehensive, continuous, collaborative care that a person with a mental illness needs and deserves.

  • People with mental illnesses are often in denial that they are ill, or they may feel unworthy of help or convinced that they can't get better, so they don't even try. Many family members, too, turn a blind eye to signs of an illness that scares and embarrasses them.
  • It's not surprising, then, that less than one in five people who need effective mental health care in this country receive it.

    My recent Huffington Post blog "Four Points of Advice for People with a Loved One with a Mental Illness" focused on these barriers, and I am writing a book for families about how to navigate the mental health system and more effectively engage and support their loved ones.

    AOL Healthy Living will especially address key issues in mental health prevention, detection, early intervention and effective treatments (medical and complementary/alternative medicine), and it will provide useful and important guidance for you and your loved ones. Stay tuned. Informed and active patients and families will be the ones that stand the best chance of benefitting from what the mental health system has to offer.

    The opinions expressed herein are solely my own as a psychiatrist and public health advocate.

    I receive no support from any pharmaceutical or device company.

    For reviews, stories and questions you want answered, visit my website,