In 2002, President Bush’s “New Freedom Commission on Mental Health”1 had a fancy title and convened a lot of meetings to discuss issues concerning mental health. Although I applauded the effort, as far as I know, nothing came of it. It is easy to hold hearings and listen to experts, but why is it so difficult to enact laws and regulations to actually make life better for those struggling with mental illness?
Listed below are some of the issues that were discussed and their findings from the commission.
- When compared with all other diseases (such as cancer and heart disease), mental illness ranks FIRST in terms of causing disability in the United States, Canada, and Western Europe according to a study by the World Health Organization (WHO, 2001).
- While many people are given good care and manage to recover, the reality is that about 1 out of every 2 people who need mental health treatment does not receive it (NHSDA, 2002).
- America’s mental health systems are fragmented. Programs charged with providing services are found at every level of government and in the private sector. They have varying missions, settings, and financing. Each funding source has its own complex set of rules which govern eligibility and payment and whether the services apply to children or adults. While many providers are dedicated, no one is ultimately responsible.
Five major barriers to receiving services for mental health illnesses were identified.
- Fragmentation and Gaps in Care for Children. About 7-9% of all children (ages 9 to 17) have serious emotional disturbances. That means that one or two kids with serious emotional problems are in virtually every classroom. Potential sources of help may include teachers, school counselors, pediatricians, family physicians, psychiatrists, clinics, psychologists, and courts.
- Fragmentation and Gaps in Care for Adults with Serious Mental Illness: Many are unemployed and go without treatment. Most strikingly, less than 30% of those with serious mental illnesses receive stable treatment. An estimated 25% of homeless persons have a serious mental disorder, and for the most part do not receive any treatment.
- High Unemployment and Disability for People with Serious Mental Illness: Undetected, untreated, and poorly treated mental disorders interrupt careers, leading many into lives of disability, poverty, and long-term dependence. This commission’s review found a 90% unemployment rate among adults with serious mental illness.
- Older Adults With Mental Illnesses Are Not Receiving Care: Depression is common among older adults. About 5-10% of them have major depression, yet most are not treated. Older men have the highest rates of suicide. They do not readily bring up their sadness and despair, their feelings of hopelessness and loss. Most worrisome is that the growing number of older Americans will soon magnify and expose existing problems.
- Mental Health and Suicide Prevention Are Not Yet National Priorities: Our nation’s failure to prioritize mental health is a national tragedy. So many lives are at stake; so many families and communities struggle to stay afloat. Over 30,000 lives are lost annually to this largely preventable public health problem. About 90% of those who take their life have a mental disorder.
The mental health system is fragmented, in disarray, and in need of dramatic reform. The system is not oriented to the single most important goal of the people it serves—the hope of recovery. It needs to integrate programs that are fragmented and increase its capacity to fulfill unmet needs.
All of this was discussed 12 years ago. And yet, unfortunately tens of millions still suffer. I just shake my head that we do not have the leadership to do something about this once and for all.
1 “Interim Report of the President’s New Freedom Commission on Mental Health”