Health Care and Mental Health

Mental health issues are a big concern for many Americans including those suffering from various illnesses, health care providers and treatment centers, government agencies, and insurance carriers. The American Psychiatric Association released a report in May, 2008, that the economic impact of lost revenues amounted to over $193 billion each year in the U.S., noting that the evidence shows that the indirect costs of mental illness are enormous. The financial loss is attributed to lost earnings from unemployment among people with mental illnesses, and lower earnings among employees as a result of 30 days or more of missing performance on the job--some of those issues include bipolar disorder, psychosis, manic depression, violent behavior, attempted suicide, depression, and panic disorder. And, in older Americans, dementia and Altzheimer's are also a significant societal problem.

A report from the US Surgeon General was recently released that speaks to mental illness and its effects on the nation. The burden of mental illness on health and productivity in the United States and throughout the world has long been profoundly underestimated. Data developed by the massive Global Burden of Disease study, conducted by the World Health Organization, the World Bank, and Harvard University, reveal that mental illness, including suicide, ranks second in the burden of disease in established market economies, such as the United States. Nearly two-thirds of all people with diagnosable mental disorders do not seek treatment. When people understand that mental disorders are not the result of moral failings or limited will power, but are legitimate illnesses that are responsive to specific treatments, much of the negative stereotyping may dissipate.

Scientific American reported in January, 2008, that in any given year 26% of American adults suffer from mental disorders, based on guidelines in the official handbook for diagnosing mental illness, the DSM-IV. Only about a fifth of the cases are serious enough to cause a major disruption of everyday life, however, which has prompted some experts to call for more stringent diagnostic criteria. Others counter that tracking mild symptoms is important for preventing their escalation into more severe illness. Nearly half of all people who have one illness also suffer from at least one more. According to the National Institute of Mental Health, even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness. In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Many people suffer from more than one mental disorder at a given time. Nearly half (45%) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.

The current editor of FierceHealthCare has recently noted that as the debate in Congress over mental health parity in health insurance illustrates, there's no consensus in our society--or even in the healthcare industry--as to how to deal with the mentally ill. But it might be a good start to expose and focus on those issues, and the role they play in creating tragedies and violence in the healthcare workplace.The lack of understanding and attention may be, in part, because mental health is on a separate track from just about all other healthcare services. Patients who present a mental health problem in primary care are referred to a psychiatrist and/or therapist, neither of which have much contact with the PCP. Patients who turn up in the emergency department with a mental health crisis are shunted to a psych ward without much of a medical workup, and they seldom get any counseling or other forms of psych support until they're placed in a bed in the psych unit. No wonder the industry is ill-equipped to deal with mentally-ill patients.

Comments continue on FierceHealth Care to state that as long as mental healthcare is not only in short supply, but is also completely walled off from routine medical care, no one in the system is likely to know how to handle these cases. This needs to change, and fast. Take the issue of nurses getting assaulted by irrational patients. Of course, it's horrible that anyone should be assaulted on the job. However, given that nurses in an ED can expect to encounter irrational and potentially violent patients regularly, why not train them in the restraint techniques used by psych specialists and give them more formal training in psychiatric management? Neither of these would prevent violent incidents from happening, but nurses would have much better tools to cope with them. And of course, it would be extremely helpful to offer counseling or other support to patients while they wait for psych services. On the primary care level, why not contract with a mental health specialist even one day a week? Patients could see the psychiatrist--or even a less-costly counselor--who would report back directly to the primary care physician and help him or her understand that patient's needs. Such coordination could prevent many a sick patient's mental illness from escalating out of control.

There may be some positive news on the near horizon. The Wall Street Journal reported today that after long negotiations, the House and Senate have come to an agreement on mental health parity. After wrangling over the issue for more than a decade, a deal has emerged that seems to satisfy a pretty wide range of interest groups. Under the bill, employers who offer mental health coverage will have to provide benefits that are comparable to those for other maladies. Under current law, it’s fairly common for plans to, say, charge higher co-pays for mental health coverage than for other kinds of health care. The bill exempts employers with fewer than 50 employees. And it allows employers to choose which, if any, mental health conditions will be covered.

According to the National Institute of Health, mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, from childhood and adolescence through adulthood. Everyone feels worried, anxious, sad or stressed sometimes. But with a mental illness, these feelings do not go away and are severe enough to interfere with your daily life. It can make it hard to meet and keep friends, hold a job or enjoy your life. Mental illnesses are common – they affect about one in five families in the U.S. It is not your fault if you have one. These disorders – depression, phobias, bipolar disorder, schizophrenia and many others - are real diseases that you cannot will or wish away. Fortunately, they are often treatable. Medicines and therapy can improve the life of most people with mental illnesses.

If you feel that you are having difficulty coping with any behavioral or mental health issue, seek professional assistance as soon as possible. Or, if you know someone that you suspect is having problems in this area, try to help them seek medical attention. It's one thing to have a "blue Monday" or feel out of sorts due to physical problems, health problems, bad news, or other temporary situations. It is altogether different to suffer from severe emotional or psychological problems that are more traumatic or long term. Even though the mental illness category covers a huge number of disorders and medical needs, the primary concern is to seek help right away. Better to get assistance in the early stage of a mental illness than to wait and suffer from a more serious diagnosis and the long term effects of ignoring the problem.

Until next time. Let me know what you think.