Mental health is a public health issue

Posted: Monday, May 22, 2000

The last six months have seen the best of times and the worst of times for mental health. The best of times were official, public events. December witnessed the release of the Surgeon General's Report on mental health, which spotlighted mental health and mental illness in America. In April, Gov. Knowles declared May Mental Health Month, focusing the beacon on Alaska mental health issues.

The worst of times were personal events. Two women experiencing mental illnesses lost their lives. Two candles stopped burning before their time, losses soon obscured by the latest news story.

The surgeon general and governor tell us that mental health is a public health issue. Mental health is fundamental to overall health, indispensable to personal well-being. Mental disorders are health conditions that can be treated as effectively as other conditions. Mental health and physical health are inseparable - mind and body interact and affect one another.

Mental health and mental illness are opposite ends of a continuum we all experience.

At one end is mental health, positive functioning characterized by productive activities, positive relationships and ability to cope with adversity. We start to move to the other end of the continuum when we encounter mental health problems, which generally involve short-term distress and impaired functioning. Specific events (divorce, death of a loved one, job loss) often trigger problems.

At the other end of the continuum, mental illness alters thought, mood or behavior leading to more severe, longer-term distress and impaired functioning. Mental health is not static but changes with time and circumstances. Most people have experienced mental health problems.

You may be surprised to learn how heavy a burden mental illness represents. It accounts for nearly one-sixth of all the years of life lost to disease, more than all cancers combined. Only heart disease is a greater public health burden to Americans. There are many reasons this is so. Mental health-related conditions prompt up to half of all visits to family doctors. Substance abuse and mental health inextricably intertwine. Up to half of people with serious mental illnesses develop alcohol or drug abuse problems. One in 10 Alaska children have a serious emotional disorder. The incidence of suicide among 15- to 24-year-olds has tripled since 1960. Nearly half of those with mental illnesses do not seek treatment.

Is it all bad news? No. Many who experience problems or illnesses recover to lead successful lives. Treatment is as effective as that for other medical conditions. Research continues to enhance our understanding of brain functions. New medications control symptoms more effectively with fewer side effects.

The real tragedy of mental illness is that so many do not seek treatment. As treatment effectiveness increases, we must help more to seek treatment. Before the millions of Americans (45,000 Alaskans) with serious mental illnesses can hear the surgeon general's and governor's message, we must tackle some real barriers to mental health.

The stigma of mental illness: If I had a heart attack, people would be concerned. But if I have a mental illness, people laugh at me. Stereotypes, fear and discrimination daily confront people with mental illnesses. Pervasive social stigma (reinforced by the popular media) discourages people with mental illnesses from seeking help.

Individual differences: Mental health has many faces differing by age, gender, race and culture. Unique needs require unique responses. Our service system often has problems responding to unique needs.

Financial barriers: The organization and financing of services are barriers to many. Health plans cut costs by reducing access and services for mental illnesses. Ninety percent of health insurance policies restrict coverage for mental illness compared to physical illness. Many people have no insurance covering mental health needs.

The surgeon general and governor have called on us to dismantle barriers to mental health by continuing to study the brain and translating scientific advances into treatment. We must adopt zero tolerance for stigma by dispelling myth and stereotype. We must educate people about effective mental health interventions. We must develop services responding to unique needs, available when and where needed. We must advocate for health insurance parity for mental health with physical health.

If we come to grips with these admittedly large problems, fewer candles will stop burning before their time. The personal tragedies behind the headlines will become less common as people discover that mental illness is not shameful and that mental health is possible.

Richard Rainery is a research analyst with the Alaska Mental Health Board.

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