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Report: Many Ignore Mental Health

Mon, Dec 13th 1999

In an exhaustive review of research on mental disorders, Surgeon General David Satcher concludes negative stigmas and difficulty paying for care are keeping millions of Americans from treatments that have been proven effective.

The sweeping report, being issued today, encourages Americans who suspect they have a mental disorder to seek help. "Mental disorders are not character flaws but are legitimate illnesses that respond to specific treatments, just as other health conditions respond to medical interventions," said the report. "Society no longer can afford to view mental health as separate and unequal to general health."

All told, mental disorders affect nearly one in five Americans. Nearly half of those with a severe mental illness do not seek treatment.

The report, a scientific rather than political document, makes no specific policy recommendations. But mental health advocates said they would seize it in fighting for equal health insurance coverage of mental ailments, better treatments in prisons and more accountability in public spending. "We've got a health crisis here and the surgeon general has documented it," said Laurie Flynn, executive director of the National Alliance for the Mentally Ill.

"Mental Health: A Report of the Surgeon General" reviews 3,000 academic studies on mental health and mental illness and has been in the works since Satcher took office in early 1997. The report's release comes at a session with Satcher and Tipper Gore, Vice President Al Gore's wife and a longtime advocate for the mentally ill.

"The report's principal recommendation to the American people is to seek help if you have a mental health problem or think you have symptoms of a mental disorder," it says. And Satcher encourages friends, family, teachers, ministers, coaches and others who may spot someone with a problem to encourage them to seek help.

But even people who want treatment can't always afford it. Even those with health insurance often find sharp limits on what their health plans will pay for.

The report stops short of recommending that the law require insurance companies to treat mental and physical health problems equally - as President Clinton and some in Congress have proposed. But it does call this coverage "an affordable and effective objective."

The nearly 500-page document examines both mental health and mental illness, calling them "points on a continuum."

Mental health involves the ability to engage in productive activities, to fulfill relationships with others, adapt to change and cope with adversity. Mental illness includes a variety of disorders characterized by alterations in thinking, like Alzheimer's disease; in mood, like depression, or in behavior, like hyperactivity.

Satcher argues that people with mental health problems and mental illnesses can live happier, more productive lives with the help of therapy and medication. Without help, someone who begins sad can become clinically depressed, and ultimately even suicidal. Untreated, the most severely ill can end up homeless or criminal. "To a great extent, we are dumping our mental health problems on the streets of America," Satcher said in an interview. "We are dumping them into our jails and prisons - there's no question about that."

The nearly 500-page report, written by a panel of experts, also:

  • Reviews scientific research into the operations of the brain, including unprecedented new examinations of complex neurochemical activity inside individual brain cells.
  • Identifies prospective and promising new treatments.
  • Examines the flaws in the system for providing mental health care, including problems coordinating government agencies, private groups, schools, prisons and other providers. -Explains that researchers know more about how to treat mental disorders than what causes them. No single gene causes disorders, the report says, but variations in several genes can contribute to unhealthy brain activity that, under certain conditions, results in mental illness.

Satcher, who has also focused on racial disparities in health, noted that black Americans are less likely to get outpatient mental health services but more likely to end up institutionalized, suggesting they are missing opportunities for important early care.

This is the 51st surgeon general's report in the nation's history; 28 of them have dealt with smoking, including a seminal work in 1964 that detailed the health risks of tobacco.

Satcher hopes this report, the first on mental health, will have a similar impact. "I hope it will help to change attitudes," Satcher said, "I hope this report really stimulates many people to care for themselves and for members of their community."

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