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Lloyd I. Sederer, MD

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

Posted: 05/16/11 07:00 AM ET

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.
  2. 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, www.askdrlloyd.com.

 
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 condi...
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 condi...
 
 
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AdorableHero
Conquer your dark side or become it.
02:20 PM on 06/24/2011
I'm bipolar. I'd been in and out of talking to therapists who misdiagnosed me as other things until I did something psychotic enough to get me arrested. No one was physically harmed and I did no time, but still... it wasn't good. I don't have transportation that's reliable enough to go to regular therapy and I find that doing art works for me most of the time. I also take lithium - no cure, but really helps me to focus. I get state-care, but have to jump through some obnoxious hoops for it.

Sometimes I wonder if there's an unspoken, underlying attitude of "let them all commit suicide. They are the weak and by culling themselves from the herd, society will be stronger." - It's a cruel thought, and one I sometimes have about myself, that maybe I ought to cull myself from the herd. But, I have thus far have found reasons not to. I find it helpful to think about a loved one finding my body *shudder.* I don't want to do that to them. I've also been cultivating a "screw the world!" attitude. I worry about those who do not have such an attitude and those who do not have reliable loved ones, though.
10:29 AM on 06/04/2011
How can we even begin to calculate the cost of mental health care in the U.S.? We should be investing heavily in educating mental health care professionals and providing mental health coverage for ALL citizens regardless of income and social class. We are paying for it the expensive way, dealing with the expensive and even deadly consequences of a patchwork system that hardly inspires trust. In my state, if a person threatens suicide and the family calls 911, the police will handcuff him and put him in the back of the police car, then drive him several counties over to to an overcrowded mental health facility where he'll be drugged into submission until the clock stops ticking on the amount of time they can house him and still get paid. Then he'll be sent home to his family with the instructions "Keep him away from anything he could kill himself with, and make sure he gets therapy. But oh, we can't tell you what he told our therapists, and you can't attend sessions with the therapist you find--if you find one. HIPPA laws prevent that. His mental state is none of your business. Have a nice day." Seriously, it is beyond barbaric. Imagine what this country could be like with high quality mental health care for all and highly trained professionals treating them.
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Emy Freeland
And... there.
10:09 PM on 06/03/2011
Unfortunately the mental health system (such as it is) is extremely reliant on the patient taking the initiative to get help. Which is a terrible idea since the patient is usually the most reluctant and we're usually the last ones to realize that we're extremely depressed or need other interventions...
09:05 PM on 06/08/2011
Good point, but at the same time, the vast majority of people need to pick themselves up by the bootstraps and fix their own mental health. Too many people play the blame game until they arrive at their grave. I personally work on self improvement and thus mental health as much quite a bit, and it takes work, but I notice not many others do - they would rather dismiss or defer the responsibility.

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10:50 PM on 05/29/2011
I'd highly suggest anyone risking psychiatric care, especially the drugs (which are very harmful and many times ineffective) to read either of both of Robert Whitaker's books on the subject ...

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

and

Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill

http://www.amazon.com/s/ref=nb_sb_ss_c_1_15?url=search-alias=stripbooks
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ignacio sanabria
Mirror synapses at work
10:19 PM on 05/26/2011
The more is written about mental illness the better, so people would understand the seriousness of these pesky disorders. It takes more than `comprehensive studies` to find a common ground to treat these disorders. Right from the very beginning a diagnosed patient must be given all the pertaining information about his disorder and what to do about it. From there, the patient will have to make hard choices, along with his family, friends and other support people. Also, the wronged idea that by just taking antidepressant X or Y she will get better is a total fallacy that must be addressed. It does not work. It only masks the symptoms. A caring psychiatrist well versed in the neurophysiobiology of the patient must prescribe the appropriate medication along with CBT, and healthy lifestyles. These situations must occur concurrent, otherwise the effects are more devastating than the disorder itself. The patient always yearns for that `miracle pill` that will take him out of his misery. This author `wasted` 10 years of his life trying to beat the disorder. He did it but he had to pay a hefty price. As a mater of fact, living a life already carries a hefty price.
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Welshish
The sadder but wiser girl for me.
11:12 AM on 05/27/2011
Thank you, Ignacio!
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Vajara
vajara
09:46 AM on 05/21/2011
It is too bad that the MH system is such a failed system--policies, practices, labels, beliefs, values, ethics, and relationship with BigPharmas, Private Hospitals and Insurance Industry. Psychiatry can no longer be trusted or respected for their lack of scientific inquiry into alternatives to drugs and awareness of whole-body-mind-spirit-emotion-social interactions, assessments and interventions that treat the whole being.

I speak from experience as I served as an administrator of a comprehensive MH/MR Center for several years and experienced the absence of prevention, followup, advocacy, and a will by psychiatry & psychology to engage in health care services and alternative medicine. Frankly, if you wish to be of service to humanity, change your behavior and your practices. Stop your drugging of everyone who walks into your offices and injuring them with labels/codes & drugs that are not valid & reliable. As a professional you know that giving someone a label for life (disorder) offers them no hope for their future and may be contributing to high suicide rates of our Injured Warriors and their Families as a population identified with these cluster of symptoms.

Stress, anxiety and depression is not a disorder or disease, rather it is a serious injury with best treatment opportunities using intensive, extensive and holistic health practices. You know you can do better as a profession, so as a leader, please discuss how you will improve the system.
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Welshish
The sadder but wiser girl for me.
10:59 AM on 05/27/2011
I worked in the mental health field, through a mental health agency, with adolescents who were diagnosed with such severe mental health issues that they were unable to attend their public schools.Everyone was on meds. Some meds were helpful, especially for those who couldn't concentrate because of the voices in their heads. The rest of the students lived lives that were chaotic and difficult. Then my own life became the same. My son went through 10 years of addiction. The stress began to deeply affect me over time, despite counter-measures. So I was diagnosed with 'major depression'. Now my son, at age 32, has now been clean and sober for well over a year. I have conveyed to my counselor that I believe I was innudated with so many 'stress-events' that each one was extending my 'normal' reaction. I have also applied CBT and DBT to my own thinking. I don't believe I needed the anti-depression meds that I took for most of that time. Now that my stress-events are low, I am losing the 50 pounds I gained while on the meds and worried that anyone who treats me will only look at my diagnosis of major depression and view everything about me through that lens. My view of meds has changed. I was dealing with a "serious injury" or injuries that kept re-injurying the wounded area. And, as such, was not appropriate for my diagnosis or my 'psycho-dynamic' treatment. Thanks Vajara.
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07:05 AM on 05/20/2011
Stargazer 28 and JOHNSPEAKS: I think that both of you can be right about different things. There are so many different kinds and levels of mental illness that each person can experience something very different. Many people who have had very severe illnesses for decades have been through really horrible experiences and may still be on really rough roads. Mental illness not only is causes symptoms but can damage or wreck one's work, relationships, just basic living due to extreme poverty, etc. I have bipolar disorder and it's been very bad. However, treatments are getting better and I am doing better. But I am fortunate not to have had complicating factors such as PTSD, substance abuse, homelessness. I have also worked on a mental health teams with clients whose conditions, such as schizophrenia, may be complicated. Meds that do great things CAN have very bad side effects, not just discomfort but huge weight gain, diabetes, cholesterol that are real health risks. So JOHNSPEAKS seems to be speaking from difficult experience and that's his truth.
The experience of Stargazer28 is valuable too and the possiblity of recovery is real, including for people with the more severe illnesses or multiple conditions.

There's nothing wrong with disagreeing, but it should be respectful. Aren't we all working for the same thing, to help people with mental illnesses and the people who love them? We're all very different, but we can share pain and hope.
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MerrieWay
04:29 AM on 05/18/2011
If a loved one is suffering with mania, psychosis, and is danger to themselves or others...they are given meeds as a treatment. If over a short period of time, they are getting worse on the Meds...the cocktail is changed. Teens have been given meds, that have been taken off the market for that age group. If someone does not improve with meds...and no other underlying causes are looked at...for the condition, that can be masked by underlying illnesses...we have a failing system.
02:03 PM on 05/17/2011
I have watched my brother go through mental illness all his life, it was fraustrating and time consuming for both me and my mother. I watch my mother spend all of her time trying to get the right treatment for my brother while dealing with him going through the motions. I then had to deal with it myself through my own child and after going back and forth to the doctor's and counselor's I decided that I would not live the same way my mother lived dealing with my brother, after my son and I established a better relationship, and I filled those voids he was missing he grew out of it and I can tell you now my son is functioning young man in Society, I know he is one of the lucky one's because Mental illness is not that simple, we were fourtunate. I know it's is a terrible thing to go through, it really puts strain on a household, you don't want to turn your back on your loved one because you know they need you, so you do all you can to keep hope alive, I commend anyone who has a loved one who suffers from mental illness, it can have very trying times.
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SithRose
Mommy, I need Cthulhu. He keeps bad dreams away.
04:43 PM on 05/16/2011
It certainly doesn't help that many mental health professionals have chosen the art of pill-pushing over determining an actual diagnosis. Pills are, after all, more profitable than therapy.
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Toonguy
Draws funny pictures
11:39 AM on 05/17/2011
And your informed opinion is based on what, exactly?
11:39 PM on 05/17/2011
Actually, it's based on math. A psychiatrist can make four times as much money on a 15-minute med check than on an hour of therapy. Look it up.
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SithRose
Mommy, I need Cthulhu. He keeps bad dreams away.
01:07 PM on 05/18/2011
I'll let you do the math for 4 patients in 1 hour vs 1 patient in 1 hour on your own. I'm sure you can manage that. Then you're welcome to read http://well.blogs.nytimes.com/2011/03/06/less-talk-more-medicine/ and the associated articles. You're also welcome to take out a subscription to the Psychiatrist Times and other publications so you can read the articles there.

You might also want to review standards of care, and realize that a single 1 hour appointment followed by monthly 15 minute med appointments is, in fact, totally insufficient to actually diagnose most mental health problems. One can come to this simple conclusion by reviewing the diagnostic tools and criteria required.

We'll leave aside personal experiences with the mental health system and the willingness of multiple psychiatrists to prescribe C2 medications based on 2 15 minute appointments instead of taking a couple of hours to actually diagnose the problem...
03:55 PM on 05/16/2011
Another reason why people don't get appropriate treatment for their mental health issues? They typically consult their primary care docs, who seem to be consistently clueless about such issues. Maybe your doctor will recognize the symptoms of depression, and if you're lucky he'll throw some pills at you, but what really needs to happen is a referral to a mental health professional. Current standards of practice demand that much.
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02:22 PM on 05/16/2011
The good news: We have some of the best facilities and resources in the world to treat mental illness. The bad news: only the wealthy have access because we do not have universal health care and the current reforms are insufficient.
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ignacio sanabria
Mirror synapses at work
10:24 PM on 05/26/2011
In addition to that, America does not have effective treatments for mental illness as of yet.
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DJ Jaffe
Founder, Mental Illness Policy Org.
09:41 AM on 05/16/2011
In NYS, where Dr. Sederer is medical director of mental health services there are 3X more people in a single jail, Rikers Island, than all state psychiatric hospitals combined. Why? OMH has abandoned treatment of serious illness in favor of less symptomatic people. Unbridled mission-creep sends people with serious mental illness to the end of the line. Example? This week OMH is hosting a "Healing Power of Art" Webinar for people who's mental disorder is they lack artistic skills, while closing state psychiatric hospitals for people with schizophrenia and serious mental illness. OMH is also opposing improving Kendra's Law so people who are real sick get real care. Sheesh.
05:50 AM on 05/16/2011
Actually there is one more major reason that people won't get supposed -Help- from the mental health industry? People with mental illness will think twice before they or there loved ones get involved with the mental health industry because of all the pain and suffering and experimentation and false hope of recovery? After a lifetime of man made pain and suffering they pick some form of -Suicide- to end their inhuman treatment at the hands of mental health professionals???
03:56 PM on 05/16/2011
what 'inhuman' treatment are you referring to? I assume you meant inhumane. Can you give some examples?
08:26 PM on 05/16/2011
-Yes- Antipsychotic drugs have horrendous side effects that -You- have to see clients deal with everyday.
-Yes- Psychosurgery is inhuman (Inhumane) experimentation on clients like -Electroshock Therapy- and -Deep Brain Stimulation- and -Deep Sleep Therapy- and -Adversion Therapy- and forms of -Lobotomy- etc..
-Yes- Brain Washing that keeps the clients and caregivers and parents coming back for more pain and suffering and false hope and then some form of -Suicide- to end there man made suffering in nine out of ten people with mental illness.
-Yes- etc. etc. etc. etc........
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MerrieWay
04:32 AM on 05/18/2011
So true , so sad.