Along with the rest of the country I have been saddened by the shooting tragedy in Tucson. The President's speech helped heal some of the wounds, but so many questions and conflicts remain to be resolved. I especially liked it when he said, "Already we've seen a national conversation commence, not only about the motivations behind these killings, but about everything from the merits of gun safety laws to the adequacy of our mental health system. And much of this process, of debating what might be done to prevent such tragedies in the future, is an essential ingredient in our exercise of self-government.
"But at a time when our discourse has become so sharply polarized — at a time when we are far too eager to lay the blame for all that ails the world at the feet of those who happen to think differently than we do — it's important for us to pause for a moment and make sure that we're talking with each other in a way that heals, not in a way that wounds."
Too often mental health issues doesn't hit the radar until a tragedy happens like that in Arizona and other places, and even then some of the stories are filled with old stereotypes and fear that fuels the stigma about mental illness and makes it that much harder for those who are suffering from it to feel comfortable about getting help. I wish we could have a rational, productive national dialogue on the subject without hysteria and finger pointing. So much more needs to be done to really understand mental health issues.
I remembered the last paper I wrote when I was in school on the subject, and decided, even though it's long, to post it here.
When my husband, David, was diagnosed with severe bipolar disorder two years ago, I knew very little about the disease. All I knew was that he had wide mood swings and anxiety attacks that made it nearly impossible for him to function normally. Receiving the diagnosis was both heartbreaking and overwhelming, and I had far more questions than answers. We were fortunate to find a psychiatrist who works well with David in managing his symptoms. When I asked him for information about the disease and how best to help David work through it, he handed me a three-page article with a general description and a few vague suggestions on how to cope with bipolar disorder. I discovered then that there needs to be more information about mental health that is easily accessible to the general public as well as to family members, clergy, and law enforcement officers.
The National Institute of Mental Health (NIMH) is an organization that focuses on understanding and treating mental illness through research. They estimate that about one in four adults, 18 and over, have a diagnosable mental disorder. In a press release dated May 7, 2008, they report that a study conducted by the World Health Organization, the World Bank, and Harvard University, found that “mental illness, including suicide, accounts for over 15 percent of the burden of disease in established market economies, such as the United States. This is more than the disease burden caused by all cancers.”
Mentally ill people are found in all walks of life, and in all classes of society. They are found in the jail population, homeless shelters, and hospitals. The U.S. Department of Health and Human Services estimates that almost 7.6 million hospitalizations in 2004 were related to mental health or substance abuse disorders.
A report on the United States public mental health care system that was conducted by the National Alliance on Mental Illness in 2009 is sobering. They found that the national average grade, based on 65 specific criteria, is a D. The economic crisis leads to budget cuts in mental health services and that causes “a vicious cycle that destroys lives and creates more significant financial troubles for states and the federal government in the long run.”
The cost to society as a whole is staggering. NIMH estimates that “major mental disorders cost the nation at least $193 billion annually in lost earnings alone.” And that number does not include the cost of medicine or doctor and hospital visits. For those afflicted with mental health concerns, finding affordable health care has long been a burden with many insurances covering mental illness at a lower rate than physical illnesses.
Statistics alone don’t tell the whole story. Behind each number is an individual who also has friends and loved ones. Mental illness doesn’t just affect the person who has the disorder; it also affects family members, friends, and coworkers. Mental and emotional disorders take a big toll on spouses, and these marriages often end in divorce. In an abstract on “Couples and Mental Illness,” Michael Crowe writes: “This is an under researched area in the mental health field, despite the fact that a large number of patients suffer from psychiatric problems and many of them are in relationships with a partner. There is typically a change in the relationship involving extra responsibilities being taken by the partner. The partner may indeed become depressed as a result of the stresses experienced. . . . Professionals need to increase their awareness of this issue, to treat the partner with understanding and to consider the stability of the relationship as part of their management.”
There has been a long history of myths and harmful stereotypes about mental illness that have caused others to misunderstand and mistreat those who struggle with mental problems. Society, as a whole, is slowly becoming more accepting, but more work needs to be done to bring it to the general public’s attention.
David J. Miklowitz, a professor of psychology at the University of Colorado, noticed the need for more mental health education and wrote a book about bipolar disorder. In the preface to his book, The Bipolar Survival Guide, he said, “I wrote this book to respond to a need voiced by virtually everyone with whom I have worked, along with their family members. People with the disorder wish for more understanding from relatives, friends, and coworkers. Their family members, in turn, want to know how best to help their bipolar relative without becoming angry, controlling, or overprotective.”
Sandy Naiman, who blogs at “Coming Out Crazy,” has suffered from the stigma associated with mental illness from the time she was a young teen. When discussing depression, she wrote, “It’s frightening. Steeped in negative stereotypes, prejudices and discrimination. “By far, the biggest barrier to gaining help with our emotional and/or mental health needs, is that we, women and men, find it so difficult to face our emotional pain and talk about it. Not only is it painful to process, it’s complicated by deeply-rooted fears about how our words and our feelings and our problems will be received. The real repercussions—like being ostracized or isolated or abandoned or losing our jobs and our security. Our connections to the people we depend on and love.”
Too often, mental health issues are only talked about when someone has a tragedy, such as what happened to Brian Cardall in June 2009. Brian had recently been diagnosed with a mood disorder, and was taking medication for it when he had a psychotic break. His wife called 911 for help. When the police officer who responded to the call tasered him, he lost consciousness and died. NAMI-UT said that Utah has a 40-hour training program on mental crisis, but that more officers need to be trained, including those in rural areas. The director of NAMI-Utah, Sherri Witwer, said “this training really does help officers identify the behaviors connected with mental illness and to adapt their approach with those people.”
A group of graduate students in social work at Brigham Young University noticed another need: members of the clergy who feel inadequate to help members of their congregations with mental health issues. They found that about 40 percent of those struggling with mental health concerns first go to their spiritual advisors for help. They recently published a manual to help clergy reach out to their congregations, and established a website to give them more information.
When I looked for information about my husband’s disorder I found a number of books and websites on the subject, but the information is scattered, and as one significant other of a bipolar sufferer commented, “most everything you find will be the same vague and uninformative list of symptoms or it’s get your dictionary out and try to follow along with the over-the-top medical terms while weeding theory from fact.” She believes that most people would like something that answers simple day-to-day life questions, and directs them to where to go for support and help with this disorder.
In my search for information I have come across several sites and organizations, such as DBSAlliance, NAMI, NIMH, the Copeland Center for Wellness and Recovery, WebMD, and PsychCentral, that have valuable information. These and other sites are helpful, but it takes a lot of time and effort to find them. There needs to be a central place on the web with information to direct those who are looking for help. For instance, the BBC has a page devoted to helping others understand mental health. The PBS website, probably the closest thing the United States has to the BBC, does not have anything comparable. More obvious links about mental health at popular sites like PBS, Google, or USAToday would be helpful for those seeking help on mental health issues.
I noticed that Great Britain is taking a proactive course to educate and break the stigma of mental illness. Three organizations funded by the British government and private organizations, Rethink, Mind, the Mental Health Charity, and Time to Change, work together to actively educate the public and reduce the discrimination that those who have mental illnesses struggle with.
In January 2009 they launched a campaign to bring mental health problems to the public’s attention. They did this through media advertising and coverage, online activities and websites, and a program to work with medical schools and teacher training colleges to help reduce the stigma of mental illness.
With these and other efforts, a British government report in June 2009 showed that public attitudes toward mental health are finally turning. They found, among other things, that:
* 77% agree mental illness is an illness like any other, an improvement of 3% on last year and up 6% since 1994
* 73% think that people with mental health problems have the same right to a job as everyone else, up 7% on last year
* 78% judge the best therapy for people with mental illness is to be a part of a normal community, up 8% on last year
They also discovered:
* 11% would not want to live next door to someone with a mental health problem, an increase from 8% since 1994
* 65% underestimated the actual prevalence of mental illness and only 13% were aware than 1 in 4 people will experience a mental health problem.
The Chief Executive at Mind, Paul Farmer, said, “We have seen some real improvements this year in the tolerance and empathy that people have toward mental health issues. There has finally been a decrease in the number of people who wrongly associate mental health problems and violence. We are also seeing attitudes turning on people’s right to employment but we can’t be complacent.”
More focused attention, education, and campaigns like Time to Change will help reduce the discrimination and prejudice that exists now toward those who are suffering with mental health challenges.
In the years since David’s illness was diagnosed I have spent hours researching the subject of mental health, trying to understand and help him manage his illness. I have learned that mental illness comes in all shapes and sizes and is as individual as the person who suffers from it. There are no easy answers, and much research still needs to be done to learn more about mental diseases, how best to treat them, and how to change public perceptions.
Sandy, from “Coming Out Crazy,” said it well when she wrote, “Depression [and other forms of mental illness] is a ‘human’ issue, not only a ‘health’ issue. In order to effect change in public policy, we need change in public perceptions. All of us have to own our emotional and mental health issues. Openly and honestly. They belong to all of us. Either indirectly or directly. . . .
“In order to heal, we must make peace with ourselves and accept ourselves, emotionally and mentally, as we endeavour to change public policies and perceptions for everyone.”
When that happens, more of those who silently suffer from the various forms of mental illness will be able to get past the stigma and receive the help they need to live happier, healthier lives.
1. Vicki Koenig, “Mental Illness—Information for Families,” Sanctuary Psychiatric Centers’ Information Network, http://www.spcsb.org/pdfs/resources/f-mental_illness.pdf.
2. National Institute of Mental Health, Statistics, http://www.nimh.nih.gov/health/topics/statistics/index.shtml. For a breakdown of specific mental illnesses included in the statistics, see http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml, accessed on July 1, 2009.
3.The Bureau of Justice, Statistics, “Mental Health Problems of Prison and Jail Inmates,” http://www.ojp.usdoj.gov/bjs/abstract/mhppji.htm. In one state, Texas, “there are almost as many psychiatrically ill inmates in the Harris County Jail on psychiatric medications as there are patients in all of the Department of State Health Services hospital beds across the entire state” (Steven B. Schnee, “Mental Illness Deluging Local Jail Facilities,” Houston Chronicle, June 27, 2009, editorial section, http://www.chron.com/disp/story.mpl/editorial/outlook/6500788.
html. Accessed on July 31, 2009.
4. National Coalition for the Homeless, “Who Is Homeless,” NCH Fact Sheet #3, June 2008, http://www.nationalhomeless.org/factsheets/who.html. Accessed on July 1, 2009.
5. Agency for Healthcare Research and Quality, Data and Surveys, Healthcare Cost and Utilization Project (HCUP), Care of Adults with Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004, http://www.ahrq.gov/data/hcup/factbk10/factbk10b.
6. National Alliance on Mental Illness, Grading the States 2009: Overview, http://www.nami.org/Content/NavigationMenu/Grading_the_States_2009/Grading_the_States_20091.htm, accessed on August 5, 2009.
7. NIMH, Science News, Science News from 2008, http://www.nimh.nih.gov/science-news/2008/mental-disorders-cost-society-billions-in-unearned-income.shtml. Accessed on July 1, 2009.
8. The U.S. Congress passed the Mental Health Parity bill (the Paul Wellstone-Domenici Parity Act) in November 2008. Beginning January 1, 2010, the bill will ensure that individuals with a mental illness will receive the same level of insurance coverage as those with a physical illness. The Depression and Bipolar Support Alliance discussed the new bill in its November 2008 update. See Depression and Bipolar Support Alliance, eUpdate November 2008: Advocacy, “The New Parity Law—How Will It Work in 2010?” http://www.dbsalliance.org/site/media_eupdateNov2008#advocacy. Accessed July 31, 2009.
9. Michael Crowe, “Couples and Mental Illness,” Sexual and Relationship Therapy (London: Carfax Publishing, Aug. 2004), 19:3.
10. David J. Miklowitz, The Bipolar Disorder Survival Guide (New York: The Guilford Press, 2002), viii.
11. The Toronto Star, http://www.thestar.blogs.com/mentalhealth. Accessed June 10, 2009.
12. Ethan Thomas, “Not All Utah Officers Get Mental-Crisis Training,” Deseret News, June 11, 2009, http://www.deseretnews.com/article/not-all-Utah-officers-get-mental-crisis-training.html. Accessed June 12, 2009.
13. Carrie A. Moore, “BYU Students Create Mental-Health Manual for Clergy,” Deseret News, April 4, 2009, http://www.mormontimes.com/
people_news/education/?id=7323. Accessed June 8, 2009. For more information, see Clergy Bridge at http://clergybridge.org.
14. MDJunction.com, http://www.mdjunction.com/forums/bipolar-in-the-family-discussions/general-support/631347-looking-for-input#63341. Comment posted on July 1, 2009.
15. BBC, “Health,” http://bbc.co.uk/health/conditions/
16. To read these organizations missions statements, go to Rethink.org, http://www.rethink.org/about_rethink/index.html; Mind.org, http://www.mind.org.uk/; Time to Change.org, htt://www.time-to-change.org.uk/home. Accessed Aug. 5, 2009.
17.http://www.time-to-change.org.uk/what-were-doing/our-campaign/about-campaign/campaign-january-2009/how-did-it-go. Accessed August 5, 2009.
18. Time to Change.com, “Attitudes Towards Mental Health Heading for Tipping Point,” June 12, 2009, http://www.time-to-change.org.uk/news/attitudes-towards-mental-health-heading-tipping point. Accessed August 5, 2009.
19. Sandy Naiman, “Coming Out Crazy,” June 10, 2009. Accessed June 12, 2009.