The mystery of mental illness has perplexed society since the dawn of man. Modern scientists, mental health professionals and, most important, the troubled individual and their families have had to grapple with the causes, effects, medical treatments and how to care for the person whose daily life is often confined within a sphere of confusion, anxiety and separation from society.
Until the second half of the 20th Century, these persons were traditionally shunned and institutionalized “for their safety and the safety others” and allowed to languish within a private hell that they were never allowed to articulate. They were also made to feel ashamed of their plight.
A “mental illness,” as defined by the Centers for Disease Control and Prevention (CDC), recognizes “collectively all diagnosable mental disorders” or “health conditions” that are characterized by alterations of thinking, mood or behavior associated with distress and/or impaired functioning.
Although May has been proclaimed National Mental Health Awareness Month, the ongoing work and research involved in uncovering the causes and developing treatment strategies for the mentally ill is an infinite charge for caregivers.
Family and friends who set out to help a loved one find their way to a “peaceful” life are often met with insistence (by the patient) that “everything is fine.” Pressing the matter usually leads to further alienation and hostility. When things become unbearable for the concerned party, a call is often made to police or a local mental health facility exclaiming: “something is very wrong”…“she’s not herself” or…“can you help?”
The most common form of mental illness would include depression, anxiety disorder, bipolar disorder, schizophrenia and what has been diagnosed of late as “frequent mental distress.” The World Health Organization reported in 2012 that unipolar depression was the world’s third most important cause of “disease burden;” meaning that this form of mental illness is among the most frequent maladies to strike mankind. The CDC that year reported 6.7 percent of American adults experience a major depressive episode each year. Worldwide, it would appear that women suffer most from depression (11.7 percent) with men being diagnosed at 5.6 percent. Ethnic differences find depression most prevalent among White persons (6.52 percent), followed by Latinos (5.17 percent) and African Americans at 4.57 percent. The economic burden of mental illness, reports the CDC, in 2012 exceeded $450 billion in the United States.
Anxiety disorder may be most common
Anxiety disorders (including panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias and separation anxiety disorder) are among the most common class of mental disorders within the general population. Anxiety disorder has a lifetime prevalence of just over 15 percent, according to the CDC, with the occurrence generally higher in developed countries. Again, the CDC reports that most anxiety disorders are more common in women with one study conducted in the late 1990s indicating that the annual cost of anxiety disorder exceeds $45 billion primarily for non-psychiatric medical treatment costs.
The median age for onset of bipolar disorder is 25 years, and it has a lifetime prevalence somewhere between four and five percent with men usually diagnosed at an earlier age than women. Bipolar disorder has been deemed the most expensive healthcare diagnosis, costing more than twice as much as depression per affected individual. For every dollar allocated to outpatient care for persons with bipolar disorder, the CDC estimated that $1.80 is spent on inpatient care suggesting that early intervention and improved prevention management may decrease the financial impact.
Schizophrenia is probably the most loosely used term for mental illness. Persons with this disease are at the highest risk of suicide: approximately one-third of persons with schizophrenia will attempt to take their life, and one out of every 10 people will, sadly, succeed. Schizophrenia is defined as a psychiatric disorder with symptoms of withdrawl into self up to and including emotional instability and detachment from reality.
“Frequent mental distress” is usually defined based on the response to questions from a psychiatrist or other mental health practitioner (e.g. “how many days in the past month have you felt depressed?”), and a positive confirmed diagnosis of 14 or more days each month that a person has revealed that they carry on under a “cloud” of depression.
The National Alliance on Mental Illness (NAMI) estimates that, over the course of one year, one in five adults will experience a form of mental illness, but less than half will receive treatment. Of the 60 million people who fall within the category of mental distress, the NAMI estimates that about 13.6 million are going about each day with a major mental illness of which they have little control over. Most often, only close family members or friends may suspect that the individual has a mental illness.
Serious mental illness costs the nation upwards of $194 billion a year in terms of lost earnings. Persons living with a mental illness are said to face an increased risk of having chronic medical conditions such as high blood pressure, eating disorders, substance abuse, ulcers or even anger management issues.
Suicide is the 10th leading cause of death in the United States (more common than homicide) and is the third leading cause of death for youth and young adults (15 to 24 years). The CDC reports that more than 90 percent of those who took their lives in 2012 had one or more mental disorders.
The murderous rampage last week in Isla Vista; the schoolhouse killings in Newtown, Conn., the Aurora, Colo., theater massacre and the series of mass killings since Columbine have often involved young people suffering from severe mental illness. About 20 percent of youth ages 13-18 years each year experience some form of severe mental illness which, in the above cases, manifested itself into an extended psychotic episode.
California gets “F” for treatment services
Last month, the Treatment Advocacy Center (TAC) gave California an “F” for the poor state of its mental commitment laws noting that, in part, the state must “… adopt a ‘need-for-treatment’ process that can provide a legal mechanism for intervening in psychiatric deterioration prior to the onset of a dangerousness or grave disability.” The TAC report gives a letter grade and noted that only 18 states recognized the “need for treatment” standard as a criterion for civil commitment.
In most states, TAC found it is almost impossible to build a legal case for commitment without first detaining the person for psychiatric examination. In fact, 12 states make no use of any court-ordered outpatient treatment, and eight of those states already have AOT (assisted outpatient treatment) laws in place.
The consequences of ignoring the needs of individuals with the most severe mental illness who are unable or unwilling to seek treatment are on display on city streets everyday. The National Institute of Mental Health (NIMH) estimates 250,000 persons nationwide with untreated psychiatric illness roam about homeless, are in county jails or serving sentences in state prisons (now housing 10 times as many mentally ill persons than do psychiatric hospitals).
Some may be part of suicide/victimization services where people with psychiatric disorders are overrepresented—they are in the local news which reports daily on violent acts committed by individuals whose families have struggled vainly to get them into treatment.
In America, the primary responsibility for treatment of mentally ill persons falls to state and local government. As a result, a person’s likelihood of receiving timely and effective treatment for an acute psychiatric disease depends largely on the state and county where he or she lives.
For about a decade through the mid-1980s, there was a strong “patients rights” movement nationwide generated by the mental health advocate community that wanted to take a closer look at criteria for institutionalizing patients. Before that, if a mentally ill person could not earn an income and provide shelter and food for themselves, they would traditionally be institutionalized.
California requires a Riese Hearing to determine whether to institutionalize a mentally ill person with the court system providing a deputy district attorney to represent the individual. Sometimes this is done against an individual’s will as a result of a court order. The 1980s saw a push to get mentally ill persons off of dwindling entitlement budgets.
During this time, the federal government mostly discarded the Mental Health Systems Act and opted to block grant funds to individual states. In the mid-1980s, some 40,000 beds in mental hospitals nationwide shut down and by 1987, Congress had passed legislation requiring all Medicaid-funded nursing homes to turn away patients who did not qualify for admission because they did not require skilled nursing care.
Mental health practitioners began to spot increasing episodes of violence—including homicides—committed by mentally ill persons who were not receiving treatment because federal funds had been eliminated, and local money did not extend far enough to counter a rising homeless population infested with alcohol and drug addiction and Post Traumatic Stress Disorder among Vietnam War veterans.
The NAMI reported last year that, although military members comprise less than one percent of the U.S. population, veterans represent 20 percent of suicides nationally. Each day, about 22 veterans take their lives.
Ambivalence in the 1980s
The sharp rise in homelessness during the 1980s may have encouraged the Reagan Administration to pursue a policy toward the treatment of mental illness that satisfied special interest groups and the demands of the business community who claimed that valuable tax dollars were improperly directed at a population that brought about their own misery and personal destruction.
Critics of the new “community” mental health policies charged that, in the rush to shrink the state hospital population, many patients were released prematurely. Some patients went off their medications after being released into the community. As a result, individuals whose behavior was considered “odd” by the community where they lived, were increasingly arrested for so-called “bothersome” habits (e.g. panhandling, vagrancy, living in homeless camps) and were incarcerated or transported to another part of town for minor civil infractions.
By decades’ end, 10 percent of America’s inmates were diagnosed with schizophrenia or manic-depressive disorders.
Today, about 60 percent of adults and almost one-half of youth ages 8 to 15 with a mental illness received no treatment the previous year. The NAMI reported in 2013 that one-half of all chronic mental illness begins by the age of 14 and three-quarters of sufferers are diagnosed by the age of 24. Decades may pass, the group found, between the first appearance of symptoms and the moment when people get help.
There are certain “indicators” of a need for mental health evaluation. Today more emphasis and resources are devoted to screening, diagnosis and treatment before illness takes over in the belief that an early diagnosis may prove the most helpful.
In the evaluation, “emotional well-being” is first being looked at more closely to include “perceived life satisfaction,” “happiness,” “cheerfulness” and “peacefulness.” Second, “psychological well-being” includes “self-acceptance,” “personal growth” (receptiveness to new experiences), “optimism,” “hopefulness,” “spirituality” and “positive relationships.” Third, “social well-being” is being reviewed by mental health experts to help steer people toward “social acceptance,” “personal self-worth,” “usefulness to society” and a “sense of community.”
“With the implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, more people will have insurance coverage and, in principle, be eligible for more care,” said NIMH director Dr. Thomas Insel at this month’s National Council for Behavioral Health Conference in New York City. “From wearable sensors to video game treatments, everyone seems to be looking to technology as the next wave of innovation for mental health care.”
There are a multitude of diagnostic and treatment services in the community that can help a person in their daily battle with mental illness or the onset thereof, including family doctors, psychiatrists/psychologists, social workers, religious leaders/counselors, community mental health centers, university- or medical school-affiliated programs and social service agencies. For more details, call the Los Angeles County Department of Mental Health at (661) 223-3817, or the Antelope Valley Partners for Health at (661) 942-4719.