Mental Health Realities

As mentioned here before, WordPress allows me to track blog visits based upon search strings that were used to refer visitors to the PolicyPub.  I have noted recently a prevalence of searches on Mental Health, likely owing to the national discussion and debate on Gun Control now taking place in lieu of the Sandy Hook Elementary shooting in December.

I recently wrote a post (Obama’s Opportunity Missed) explaining why I feel the President missed a golden opportunity to raise the level of social awareness and consciousness concerning the difficult and growing challenges that mental and behavioral health present to our society.  As a follow up to that, I wanted to share with Pub visitors information that was recently presented by Pamela Hyde, the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), at the Third Annual Public Health Law Research Meeting in New Orleans on January 18th.

According to Ms. Hyde, “people are just beginning to wake up to the knowledge that behavioral health issues are so common . . . “ yet among the eight million people worldwide in the past year who had a mental illness or substance abuse disorder, only 6.9% received treatment.  She added that, “the country has to spend as much time helping children develop their emotional skills as they do their soccer skills.” 

Links to Ms. Hyde’s slide presentation, data cites, and meeting Q&A can be found at the bottom of this post.  Provided below are a few snippets taken directly from her presentation that I found particularly impactful.

Prevalence & Incidence
Approximately one-half of all Americans will meet criteria for mental illness at some point in their lives

Mental and Substance Use Disorders rank among the top 5 diagnoses associated with 30-day readmissions, accounting for about one in five of all Medicaid readmissions (12.4 percent for Mental Disorders and 9.3 percent for Substance Use Disorders)

7% of the adult population (34 million people), have co-morbid mental and physical conditions within a given year

Co-morbid depression or anxiety increases physical and mental health care expenditures

Impact on Physical Health
24 percent of pediatric primary care office visits and ¼ of all adult stays in community hospitals involve Mental or Substance Use Disorders

Adults who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of hypertension, asthma, diabetes, heart disease, and stroke

Cost of Care
Average monthly expenditure for a person with a chronic disease and depression is $560 dollars more than for a person without depression

General medical costs were 40% higher for people treated with bipolar disorder than those without it

Perception of Value
Mental illnesses account for 15.4% of total burden of disease, yet mental health expenditures in the U.S. account for only 6.2%

The public is less willing to pay to avoid mental illnesses compared to paying for treatment of medical conditions

Top reasons for not receiving treatment include:
     • Inability to afford care (50.1%)
     • Problem can be handled without care (28.8%)
     • Not knowing where to go for care (16.2%)
     • Not having the time (15.1%)

The SAMHSA Web site referenced above includes a large knowledgebase of useful, understandable resources and information on mental/behavioral health and substance abuse.  If you are interested in learning more about the very difficult public policy issues surrounding Mental Health, I invite you to check it out.


Link to Slides: Click …

Link to Q&A: Click …

Obama’s Opportunity Missed

The human mind can be a very scary place.  There is where originates the electrochemical impulses that direct the body in carrying out some very heinous acts – such as the violence witnessed in Newtown, Connecticut just over one month ago today.

The mind can also be a fascinating study of unimaginable intricacy. In some infinitesimally small space wherein exists a hidden mystery explaining the difference between a physiological existence and conscious existence lies all of the energy necessary to create and destroy humanity (sort of like Einstein’s Special Theory applied to neural mass). Can you think of a more interesting basis upon which to initiate a metaphysical discussion over Creationism?

But alas, this isn’t Sparky’s Philosophy Shop.  As alluded to above, the topic of this post is Mental Health and the policy discussion it is receiving in lieu of the fatal connection between mental illness and gun violence.  Earlier today, President Obama announced a Plan to Protect our Children and our Communities by Reducing Gun Violence.  The plan outlines a number of initiatives – including 23 Gun Violence Reduction Executive Actions – that, taken together, is an attempt to put forth a reasonable agenda on gun control policy.

Of course, the cable news networks will be filled over the days ahead with talking heads who would have us believe we are now full bore on the doomsday expressway with the only two exits ahead being socialism or anarchy – and little room in between to continue having intelligent and constructive debate on how to find the most broadly acceptable policy balance between honoring and defending the second amendment while doing whatever is possible and pragmatic to prevent future tragedies like that at Sandy Hook Elementary School.

I hope rigorous and informed debate continues on the role mental illness plays in the tragedies that have brought us to this place.  And I desperately hope that debate will raise awareness of just how acute the challenges are we face as a society  resulting from mental and behavioral health issues.  If you have not already read Liza Long’s blog post, I am Adam Lonza’s Mother, it poignantly depicts the painful and helpless reality that mental illness can cause in a family.

I believe the President’s Plan on gun control offers some reasonable ideas, most of which probably won’t go very far in the House – partly because their source is the White House and partly because of understandable concerns by some House members that significant elements of their constituencies equate any discussion of gun “control” with an armed government takeover.  But the politics of gun control aside, the reality is that very often a mentally ill individual with an agenda can kill with or without a gun.  Getting guns out of the wrong hands does not address this challenge.

Or, to look at it another way – if I had to choose one investment over the other as having a greater long-term probability of reducing gun violence, I would choose investing in mental health over more gun controls.  Yet while mental health is addressed in the President’s plan, it seems like it was almost an afterthought.  The irony is disturbing because not only do policy issues stemming from mental illness and gun violence warrant a great deal more attention – but so do a host of other issues that recognize the growing awareness of the costs that poor mental health have on society – especially healthcare costs.

Although it is still a very long journey, every day science advances a step closer to understanding the raw dynamics of how the mind and body work in synthesis to have a dramatic impact on our health. Community and individual health and wellness initiatives are now focused on taking a holistic approach.  The connection between mental health and chronic disease and disability, particularly in the senior population (see my post on substance abuse among that population) offers promising opportunities to reduce disease incidence and increase the value of treatments.

To achieve the benefits of those opportunities, however, mental and behavioral health services must be socially and culturally viewed on a par with traditional medical/health services.  In defining essential health benefits that insurance companies must provide, the Affordable Care Act helps advance that initiative.  It falls short, however, of achieving true parity status for mental and behavioral health services.

The President attempted to address that discrepancy today through executive order by committing to finalize health parity regulations – and he also outlined the need to bolster mental health counseling and awareness through additional resources that will certainly not be forthcoming from a Congress (which includes the Senate) that cannot even agree to disagree for fear of reprisal (or am I getting that confused with accountability).  But I think the President missed a tremendous opportunity today to raise awareness and urgency on the critical role mental and behavioral health services must play in developing a healthcare delivery system that is truly committed to improving outcomes while reducing costs.




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