Ray was just like someone you have known for a long time. He was respected, known for his good work, and liked. Ray ran a senior program in rural Arkansas. One day, after leaving work he drove home, parked his car in the drive way and then killed himself.

Ray is not his real name, but the story is true. Almost half of all Americans have a relative or close friend who has attempted suicide according to a new study released by the American Foundation for Suicide Prevention.

While Americans are becoming more open about mental health issues, for many it is still a taboo subject. One reason is the stigma associated or attached to mental illness. Another is the fear or belief mental illness is not a "real" illness.

It is real, especially for older Americans. Worried about an older person's driving ability? Think abut this: Elderly white men are more likely to commit suicide than to die in a motor vehicle accident.

Suicide rates increase with age and are highest among Americans age 65 and older. Older Americans make up 12.5% of the US population, but commit 20% of all suicides.

Mike Wallace, CBS News correspondent, former first lady Barbara Bush, actor Rod Steiger, actress Winona Ryder, Tipper Gore, William Styron (author of Sophie's Choice), singer Wynonna Judd and other well know individuals have talked publicly about their experiences with mental illness.

Even people who make a living out of humor can experience depression. Art Buchwald, a Pulitzer Prize-winning columnist spoke on Larry King Live with Wallace and Judd about their experiences with mood disorders. That segment of Larry King Live remains the most requested video in the program's history.

Clinical depression is one of the most common mental illnesses, affecting more than 19 million Americans each year. Six million of our nation's 33 million older Americans suffer depression.

Depression causes people to lose pleasure from daily life, can complicate other medical conditions, and can even be severe enough to lead to suicide.

However, it is a very treatable condition, with more than 80% of those who seek treatment showing significant improvement.

Unfortunately many barriers prevent treatment. 1. Stigma. People don't think mental health disorders are real illnesses. 2. Identification. Patients and their primary care physicians often fail to recognize depression. 3. Lack of adequate insurance coverage-Medicare pays less than half what other insurance provider's pay. Private plans often require separate deductibles and co-pays for mental health services-or don't cover mental illness at all. 4. Lack of providers with training/experience with older clients. 5. In today's environment of managed care and specialist, doctors don't know their patients and depression is easier diagnosed in a context.

Ageism also plays a role. Researchers sent doctors a description of Sam, a hypothetical patient with symptoms of suicide. But, some doctors were told Sam was 38 and employed, while others were told Sam was 78 years old and retired. Doctors were more likely to offer treatment to the middle aged Sam.

Because symptoms associated with depression can be passed off as a natural sign of aging or mistaken for another illness, it often remains undiagnosed and untreated in older individuals. Nine out of ten depressed elderly men and women receive no treatment for it.

Tragically, almost 40% of older Americans who commit suicide had visited their doctor in the preceding week.

Dr. Charles Reynolds writing in the American Journal of Psychiatry emphasizes depression is not a natural part of aging. "It is important for the elderly and their families know that effective treatments do exist." His and other studies show that a combination of talk therapy and medication may be the most effective way to treat depression in old age.

Important life tasks remain for individuals as they age. Older individuals continue to learn and contribute to society. Continued intellectual, social and physical activity throughout the life cycle are important for the maintenance of mental health in late life. According to US Surgeon General, treating older adults with mental disorders accrues other benefits to overall health by improving the interest and ability of individuals to care for themselves and follow their doctor's advice, particularly about taking medications.

Furthermore, if not treated, depression can lead to deaths from other diseases, such as heart disease and possibly cancer.

From a public policy perspective, decision makers at all levels should recognize the mental health needs of our country's aging population are not being met. Of what other illness can it be said 9 out of 10 affected go untreated? Not identifying and treating the disease results in unnecessary suffering for individuals, family and friends. Financially, late-life depression is costly because of the excess disability that it causes and its harmful interaction with physical health.

The problem is not going away but will only worsen in the coming years. Researchers at the Harvard School of Public Health state that by the year 2020 severe depression will be the second largest cause of death and disability.

As a nation we need to come to terms with this fact--mental illness is real.

Below is a list of symptoms of depression and resources for help.

Symptoms of depression from Screening for Mental Health, Inc.

• persistent, sad, anxious or empty mood
• decreased energy, a feeling of fatigue
• difficulty concentrating or making decisions
• restlessness or irritability
• inability to sleep or oversleeping
• changes in appetite or weight
• unexplained aches and pains
• thoughts of death or suicide
• difficulty doing things done in the past
• feeling hopeless about the future
• difficulty in making decisions
• feeling worthless and not needed
• no longer enjoying once enjoyable activities

Getting Help, Suggestions from the National Institute on Aging
The first step to getting help is to accept that help is needed. The subject of mental illness still makes some people uncomfortable. Some feel that getting help is a sign of weakness. Many older people, their relatives, or friends may believe, mistakenly, that a depressed person can quickly "snap out of it" or that some people are too old to be helped.

Once the decision is made to get medical advice, start with the family doctor. The doctor should check to see if there are medical or drug-related reasons for the depression. After a complete exam, the doctor may suggest talking to a mental health specialist.

Be aware that some family doctors may not understand about aging and depression. They may not be interested in these complaints. Or, they may not know what to do. If your doctor is unable or unwilling to take seriously your concerns about depression, you may want to consult another health care provider who can help such as a psychologist or physiatrist.

If a depressed older person won't go to a doctor for treatment, relatives or friends can help. They can explain how treatment may help the person feel better. In some cases, when an older person can't or won't go to the doctor's office, the doctor or mental health specialist can start by making a phone call. The telephone can't take the place of the personal contact needed for a complete medical checkup, but it can break the ice. Sometimes a home visit can be set up.

Don't avoid getting help because you are afraid of how much treatment might cost. Short-term psychotherapy, with or without medication, will work in many cases. It is often covered by insurance. Also, community mental health centers offer treatment based on a person's ability to pay.

For More Information
Many groups offer more information on depression and older people. The following list can help get you started:

In Arkansas:

The Division of Mental Health Services provides the majority of direct services through the state by contracting with 15 community mental health centers (CMHCs). Each CMHC is required to provide a full array of traditional and specialized, outpatient services within a defined geographical area called a catchment area. These services include: diagnostic evaluation, treatment planning, individual therapy, group therapy, medication management, case management, crisis services, vocational, housing and educational support, transportation, and rehabilitative and day treatment services. There are 15 catchment areas in which the CMHCs have service sites in 70 of the 75 counties. The CMHCs provide services from more than 150 service sites throughout the State of Arkansas.

Telephone (501) 686-9164 or 1-800-227-0007
TTD (501) 686-9176
4313 West Markham
Little Rock, AR 72205
Web site: http://www.state.ar.us/dhs/dmhs/

or

NAMI Arkansas is a private, non-profit organization that exists to help people with mental illness, their families and the community. NAMI-Arkansas is a grassroots organization dedicated to improving the lives of persons with severe mental illnesses. NAMI-Arkansas, formerly known as Arkansas Alliance for the Mentally Ill (AAMI), operates a statewide organization and coordinates a network of support groups and field services throughout the state. Support groups, programs, and activities offered by the organization are open to all family members.

Telephone 501-661-1548 or 1-800-664-0264
4313 W. Markham
Hendrix Hall Room 233
Little Rock AR 72205
Web site: http://www.nami.org/about/namiar/index.htm

National Resources:

The National Institute of Mental Health's (NIMH) special DEPRESSION Awareness, Recognition, and Treatment Program offers several publications, including "If You're Over 65 and Feeling Depressed: Treatment Brings New Hope." Contact the Information Resources and Inquiries Branch, NIMH, Room 7C-02, MSC 8030, Bethesda, MD 20892-8030; 800-421-4211. Visit the website at http://www.nimh.nih.gov

The National Depressive and Manic Depressive Association (National DMDA) has over 200 chapters in the United States and Canada offering support to people with depression and their families. They sponsor education and research programs and distribute brochures, videotapes, and audio programs. Write to the National DMDA, 730 N. Franklin Street, Suite 501, Chicago, IL 60610-3526; call 800-826-3632. Visit their website at http://www.ndmda.org.

The National Alliance for the Mentally Ill (NAMI) has a Medical Information Series that provides patients and families with information on several mental illnesses and their treatments, including the publication "Understanding Major Depression: What You Need To Know About This Medical Illness." NAMI state affiliates provide emotional support and can help find local services. Write or call NAMI at 200 North Glebe Road, Suite 1015, Arlington, VA 22203-3754; 800-950-NAMI (6264). The website is http://www.nami.org.

The National Mental Health Association (NMHA) publishes information on a variety of mental health issues and has special information on depression and its treatment. NMHA also provides referrals and support. Write or call the NMHA Information Center, 1021 Prince Street, Alexandria, VA 22314-2971; 800-969-6642. Visit the website at http://www.nmha.org.

The American Association for Geriatric Psychiatry (AAGP) is a national professional organization of specialists in geriatric psychiatry. It provides teaching materials and brochures about selected mental health disorders, including depression. Write to Publications, AAGP, 7910 Woodmont Avenue, Suite 1350, Bethesda, MD 20814-3004. Visit the website at http://www.aagpgpa.org.

The American Psychological Association (APA), the professional and scientific organization for the practice of psychology, has several brochures and fact sheets for consumers and health professionals, including a pamphlet "What You Should Know About Women and Depression." Write or call APA Public Affairs, 750 First Street, NE, Washington, DC 20002-4242; 800-374-3120. The website is http://www.apa.org.

The National Institute on Aging (NIA) distributes Age Pages and other materials on a wide range of topics related to health and aging. For a list of free publications, write to the NIA Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057; or call 800-222-2225, or 800-222-4225 (TTY). Visit the website at http://www.nih.gov/nia/.

The Alzheimer's Disease Education and Referral (ADEAR) Center is a clearinghouse supported by the NIA with information on Alzheimer's disease and related disorders. For information about depression for Alzheimer's patients and caregivers, contact the ADEAR Center at P.O. Box 8250, Silver Spring, MD 20907-8250; 800-438-4380. Visit the ADEAR Center's website at http://www.alzheimers.org.