Mental Health Gets Noticed

Reports on mental health services in the United States (US). Ranking of mental illness as a cause of disability in major market economies; Reasons half of people with severe mental illness do not seek treatment; Recommendations to overcome mental health problems.

By David Satcher, published on January 01, 2000

I am pleased to issue the first-ever Surgeon General's Report on MentalHealth. In doing so, I am alerting the American people that mental illness is a critical public health problem that must be addressed immediately. As a society, we assign a high priority to disease prevention and health promotion; so, too, must we ensure that mental health and the prevention of mental disorders share that priority.

Mental illness is the second leading cause of disability in major market economies such as the United States, with mental disorders collectively accounting for more than 15% of all disabilities. Mental disorders--depression, schizophrenia, eating disorders, depressive (bipolar) illness, anxiety disorders, attention deficit hyperactivity disorder and Alzheimer's disease, to name a few--are as disabling and serious as cancer and heart disease in terms of premature death and lost productivity.

Few Americans are untouched by mental illness, whether it occurs within one's family or among neighbors, co-workers or members of the community. In fact, in any one year, one in five Americans--including children, adolescents, adults and the elderly--experience a mental disorder. Unfortunately, over half of those with severe mental illness do not seek treatment. This is mostly due to some very real barriers to access, foremost among them the stigma that people attach to mental illness and the lack of parity between insurance coverage for mental health services and other health care services.

Over the past 2 5 years, there has been a scientific revolution in the fields of mental health and mental illness that has helped remove the stigma. The brain has emerged as the central focus for studies of mental health and mental illness, with emphasis on the activities that underlie our abilities to feel, learn, remember and, when brain activity goes awry, experience mental health problems or a mental illness. We now know that not only do the workings of the brain affect behavior, emotions and memory, but that experience, emotion and behavior also affect the workings of the brain.

As information about the brain accumulates, the challenge then becomes to apply this new knowledge to clinical practice.

Today, mental disorders can be correctly diagnosed and, for the most part, treated with medications or short-term psychotherapy, or with a combination of approaches. The single most explicit recommendation I make in my report is to seek help if you have a mental health problem or think you have symptoms of a mental disorder. It is my firm conviction that mental health is indispensable to personal well-being and balanced living. Overall quality of life is tremendously improved when a mental disorder is diagnosed early and treated appropriately.

My report presents an in-depth look at mental health services in the U.S. and at the scientific research that supports treatment interventions for people with mental disorders. Summarized briefly below, it attempts to describe trends in the mental health field; explore mental health across the human life span; examine the organization and financing of mental health services; and recommend courses of action to further improve the quality and availability of mental health services for all Americans. The report's conclusions are based on a review of more than 3,000 research articles and other materials, including first person accounts from people who have experienced mental disorders.

A Vision for the Future

I cannot emphasize enough the principal recommendation of my report: Seek help if you think you have a mental health problem or symptoms of a mental disorder. But because stigma and substantial gaps in the accessibility to state-of-the-art mental health services keep many from seeking help, I offer the nation the following additional recommendations, which are intended to overcome some of these barriers:

o Continue to Build the Science Base: As scientific progress propels us into the next century, there should be a special effort to address pronounced gaps in current knowledge, including the urgent need for research relating to mental health promotion and illness prevention.

o Overcome Stigma: An emerging consumer and family movement has, through vigorous advocacy, sought to overcome stigma and prevent discrimination against people with mental illness. Powerful and pervasive, stigma prevents people from acknowledging their mental health problems and disclosing them to others. To improve access to care, stigma must no longer be tolerated. Research and more effective treatments will help move this country toward care and support of the ill--and away from blame and stigma.

o Improve Public Awareness of Effective Treatments: Mental health treatments have improved by leaps and bounds over the past 25 years, but those treatments do no good unless people are aware they exist and seek them out. There are effective treatments for virtually every mental disorder. For more information on how to take advantage of them, call (877) 9MHEALTH.

o Ensure the Supply of Mental Health Services and Providers: Currently, there is a shortage of mental health professionals serving children and adolescents, elderly people with serious mental disorders and those who suffer from mental illness-related substance abuse. There is also a shortage of specialists with expertise in cognitive behavioral therapy and interpersonal therapy--two forms of psychotherapy that have proven effective for many types of mental health problems.