US reminder on mental health burden

Abstract

According to a new report by the United States Surgeon General, “about one in five Americans experiences a mental disorder over the course of a year”. 15% of US adults seek some kind of mental health care each year; for those between the ages of 9 and 17 years, the proportion is even higher, 17%. And the high prevalence of mental disorders in the USA is not unique to that nation. Indeed, according to the Global Burden of Disease study, mental illness ranked second, behind cardio vascular disease in 1990.Despite its prevalence, however, mental illness remains underreported, largely because of stigmatisation, “the most formidable obstacle to future progress in the arena of mental illness and health”. Not surprisingly, one of the consequences of stigma is missed opportunities for treatment. According to the report, nearly two-thirds of all people with diagnosable mental conditions do not seek treatment. This is an even greater problem in rural areas and among the elderly and children. One of the more enlightening approaches of the report is its insistence that “mental health and mental illness are dynamic, ever-changing phenomena”. About 20% of American adults are afflicted at one point or another in their lifetime and the report points out that understanding the causes may not be as simple as once was thought. “In years past, the onset, or occurrence, of mental illness in the adult years, was attributed principally to observable phenomenon—for example, the burden of stresses associated with career or family, or the inheritance of a disease viewed to run in a particular family”. But, the authors continue, “such explanations now may appear naive at best”.The report then goes on to discuss the myriad influences and aetiological possibilities for mental illness. While this may seem simple to those in the field, it does a service for the public, for whom mental illness is too often still regarded as merely the result of a single, discreet and difficult situation. A recurrent theme in contemporary healthcare—especially in the era of computerisation and massive database—is patient confidentiality. In mental health the assurance of confidentiality between therapist and client is essential, especially given the stigma of mental disease or treatment. In this regard, the report notes that while state and federal laws attempt to protect confidentiality, the legislation is often “incomplete”. The US Supreme Court recently upheld the privacy of the therapist-client relationship. Still, there is a distance to go to ensure that confidentiality is never in doubt.It should come as no surprise, given the number of uninsured in the USA, that mental health often gets neglected when it comes to insurance coverage. Public opinion polls, cited in the report, point out the US public's willingness to pay for treatment of severe mental illness such as schizophrenia and depression, but the generosity seems to stop there. The threat of higher taxes or insurance premiums seems a strong deterrent to public support for therapy for all but the most severely afflicted. The report has been criticised in the US press for being too generous or bold in its goal to prevent mental illness or treat many whose mental distress might not rise to the level of true “illness”. This critique seems reasonable, at least in a country that has not yet put the highest priority on healthcare for all of its citizens.It is possible that at some point prevention of mental illness and treatment of “lesser” mental illnesses will be considered critical, but that is something that will require a change in the heart of the American taxpayer, who is also the American voter. Perhaps, more than anything else, the Surgeon General's report is yet another call to action to a society that seems unwilling to face up to the fact that treatment of illness and prevention of illness—whatever its type—are functions of societal compassion and cohesion. According to a new report by the United States Surgeon General, “about one in five Americans experiences a mental disorder over the course of a year”. 15% of US adults seek some kind of mental health care each year; for those between the ages of 9 and 17 years, the proportion is even higher, 17%. And the high prevalence of mental disorders in the USA is not unique to that nation. Indeed, according to the Global Burden of Disease study, mental illness ranked second, behind cardio vascular disease in 1990. Despite its prevalence, however, mental illness remains underreported, largely because of stigmatisation, “the most formidable obstacle to future progress in the arena of mental illness and health”. Not surprisingly, one of the consequences of stigma is missed opportunities for treatment. According to the report, nearly two-thirds of all people with diagnosable mental conditions do not seek treatment. This is an even greater problem in rural areas and among the elderly and children. One of the more enlightening approaches of the report is its insistence that “mental health and mental illness are dynamic, ever-changing phenomena”. About 20% of American adults are afflicted at one point or another in their lifetime and the report points out that understanding the causes may not be as simple as once was thought. “In years past, the onset, or occurrence, of mental illness in the adult years, was attributed principally to observable phenomenon—for example, the burden of stresses associated with career or family, or the inheritance of a disease viewed to run in a particular family”. But, the authors continue, “such explanations now may appear naive at best”. The report then goes on to discuss the myriad influences and aetiological possibilities for mental illness. While this may seem simple to those in the field, it does a service for the public, for whom mental illness is too often still regarded as merely the result of a single, discreet and difficult situation. A recurrent theme in contemporary healthcare—especially in the era of computerisation and massive database—is patient confidentiality. In mental health the assurance of confidentiality between therapist and client is essential, especially given the stigma of mental disease or treatment. In this regard, the report notes that while state and federal laws attempt to protect confidentiality, the legislation is often “incomplete”. The US Supreme Court recently upheld the privacy of the therapist-client relationship. Still, there is a distance to go to ensure that confidentiality is never in doubt. It should come as no surprise, given the number of uninsured in the USA, that mental health often gets neglected when it comes to insurance coverage. Public opinion polls, cited in the report, point out the US public's willingness to pay for treatment of severe mental illness such as schizophrenia and depression, but the generosity seems to stop there. The threat of higher taxes or insurance premiums seems a strong deterrent to public support for therapy for all but the most severely afflicted. The report has been criticised in the US press for being too generous or bold in its goal to prevent mental illness or treat many whose mental distress might not rise to the level of true “illness”. This critique seems reasonable, at least in a country that has not yet put the highest priority on healthcare for all of its citizens. It is possible that at some point prevention of mental illness and treatment of “lesser” mental illnesses will be considered critical, but that is something that will require a change in the heart of the American taxpayer, who is also the American voter. Perhaps, more than anything else, the Surgeon General's report is yet another call to action to a society that seems unwilling to face up to the fact that treatment of illness and prevention of illness—whatever its type—are functions of societal compassion and cohesion.