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Modernize Mental Health

"I am now the most miserable man living.  If what I feel were equally distributed to the whole human family, there would be not one cheerful face on earth.  Whether I shall ever be better, I cannot tell.  To remain as I am is impossible.  I must die or be better it appears to me."

— Abraham Lincoln

Worldwide, depression is the leading cause of years lost because of disability.  When depression coexists with other illnesses, such as an acute hearth problem, it can be an independent risk factor for death according to the New England Journal of Medicine (NEJM).

Individuals as diverse as Abraham Lincoln, Virginia Woolf, Mike Wallace, Brooke Shields, Anne Rice, Billy Joel, Dick Cavett, Harrison Ford, Terry Bradshaw, and Winston Churchill have had a serious mental illness.

Despite the prevalence and severity of depression, today’s approach to mental health is outdated.  Not on the medical side — there are proven, cost effective ways to treat depression.  The problem is the majority of people with diagnosable mental health disorders, regardless of race or ethnicity, do not receive treatment.  

The stigma surrounding mental illness is a powerful barrier to reaching treatment. Mental Health: A Report of the Surgeon General found individuals with mental illness feel shame and fear of discrimination about a condition that is as real and disabling as any other serious health condition.  Perhaps that shouldn’t be surprising since Medicare and most private insurance companies treat mental health differently than other illnesses. 

Society needs to modernize its view of mental health by treating depression and other behavioral health problems the same as physical illnesses. 

Insurance coverage would be a good start.   The NEJM states, “People with private health insurance who seek care for mental conditions generally face higher coinsurance and more limits to coverage—including limits on the numbers of outpatient visits and impatient days—than do those who require care of other health conditions.  These restrictions reduce the use of mental health services and force persons who have mental health problems to bear crushing financial costs for necessary treatment.”

The Journal states it need not be this way.  They report on the results of the first controlled study in twenty years of treating mental health insurance benefits like other diseases.  This is referred to as “mental health parity”:  “The compelling evidence presented suggests that in today’s environment, parity in health insurance coverage is both economically feasible and socially desirable.”

Beyond parity, as a society we need to stop the stereotyping of people with mental illness.  We are bombarded with negative images of people with mental illnesses. The media and entertainment industries overwhelmingly present people with mental illnesses as dangerous, violent and unpredictable individuals.  These inaccurate and unfair portrayals shape the public perception of those who suffer from mental disorders as people to be feared and avoided.  

Mental health issues like depression among older Americans deserves our full attention.  Approximately 20% of elderly people above the age of 60 have some depressive symptoms, but an identifiable diagnosis of depression is made only in 5% of the elderly population. However, the World Health Organization (WHO) states depression occurs frequently among the medically ill elderly population where nearly 30% have associated depression.  Depression is very common among residents of nursing homes.  In spite of its common occurrence, depression among the elderly frequently remains undetected.  Very often, depression is attributed to the aging process and no intervention is sought or provided states the WHO. 

The NEJM says elderly patients with major depression, including those having a first episode, are at high risk for recurrence of depression, disability and death.  The good news is patients with major depression who had an initial treatment with an appropriate class of antidepressant medication and psychotherapy were less likely to have recurrent depression if they received two years of maintenance therapy with a specific class of antidepressant medication. 

Division of Aging and Adult Services
Herb Sanderson, Director
PO Box 1437 - Slot S-530
Little Rock AR 72203-1437
Telephone: (501) 682-2441
Fax: (501) 682-8155