A Recovery for Americans’ Mental Health

As Congress and the administration consider a new stimulus, they need to repair the recession's damage to Americans' mental health.

We are seeing what we've known for decades: job losses and economic uncertainty increase the rate of psychiatric symptoms, the rate for suicide and the demand for mental health services.

Calls this year to suicide crisis lines have increased sharply, with a large percentage linked to economic distress.

A just released national survey found that jobless Americans are four times more likely than those with jobs to report severe levels of psychiatric symptoms. They also are four times more likely to have thought of killing themselves. Even those who have full-time employment but who were forced to make a job change during the last year are affected. This group is twice as likely to report severe psychiatric symptoms.

People with mental health and substance use conditions have traditionally not been well served by the health care system. When funding is tight, behavioral health services are among first to be cut. In a recent survey of state mental health agencies, 85 percent of those responding cut services in 2009. Over the next three years, these agencies are predicting a 21 percent reduction in expenditures while 44 percent of the states report an increased demand for community mental health services.

This only places the vulnerable more at risk. Persons with serious mental illness served in public mental health systems die, on average, 25 years earlier than the general population. Nearly 33,000 persons take their own life each year-roughly twice the annual number of homicides. This was the state of public mental health before the recession; the situation is likely much worse now.

We could not spend resources more efficiently than on improving care for behavioral health conditions because they are among the most chronic and disabling conditions affecting the U.S. population. Research shows that individuals with chronic health conditions who also have a mental health disorder, such as depression, are likely to experience worse functional disability, a poorer quality of life, and, in some instances, higher mortality, than individuals whose chronic health conditions are not co-morbid with mental disorders. One study even indicates that depression contributes to the risk of heart disease as much as diabetes, high cholesterol, or obesity.

Health reform could change this picture. In the above-mentioned survey, 42 percent cited cost or lack of insurance as reasons why they hadn't consulted a health professional about their mental health or substance use. But an overhaul is only a long-term solution. We need an immediate response.
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With unemployment forecast to remain high, health status and social disruption will only worsen if we continue to neglect mental health. This is particularly tragic because we have the knowledge and tested techniques that are "shovel-ready" to help children and adults manage threats to their mental health. We have effective treatments that combat the symptoms of mental illness resulting in recovery rates comparable to or exceeding those of treatments for many other health conditions.

We missed an opportunity when the stimulus bill omitted any dedicated funding for the Substance Abuse and Mental Health Services Administration. Resources should have been directed toward bolstering safety net services as well as public education campaigns to help American's better cope with the economic uncertainty.

It's time we invested in our human infrastructure that has become so dangerously frayed. We can't leave these challenges unaddressed and wait for the economic recovery to help Americans recover their mental health.