Category Archives: Behavioral/mental health
Mental health has become a more prominent topic since the recent shooting in Newtown, Conn., that claimed 26 lives, 20 of them children. The Alliance for Health Reform, a non-profit group based in Washington, D.C., that provides information to journalists and Congressional staff on health reform issues, released some key numbers on mental health issues recently that can be useful in moving the discussion forward:
- An estimated 45.9 million adults in the United States age 18 or older had any mental illness in 2010 (one out of five people in this age group).
- In 2010, an estimated 31.3 million adults received any kind of mental health service during the past year.
- Among adults with severe mental illness, 60.8 percent received mental health services during the past year.
- An estimated 11.1 million adults reported an unmet need for mental health care in the past year. Of those, 5.2 million had not received any mental health care at all in the past year.
- People who are out of work are four times as likely as those with jobs to report symptoms consistent with severe mental illness.
- The cost of care is the reason most often given by people who recognize that they need mental health treatment but don’t get it.
According to research by the Alliance, mental illnesses range from occasionally troubling to life-consuming. To cope with temporary problems, such as depression following illness or a traumatic event, many people need only a short-term intervention. But others experience more debilitating and long-lasting conditions that interfere with routine activities such as work, school and family, and can require lifelong treatment.
Effective, well-documented treatments for mental illness and substance abuse have been developed and widely disseminated, including psychotherapy, psychosocial treatment and prescription medications. But a significant number of Americans do not have adequate access to mental health treatment or do not take advantage of available help.
A recent article in the Washington Post looks at ongoing clinical trials that have researchers studying the potential effects of transcendental meditation as a treatment for post-traumatic stress disorder (PTSD). As many as 10 percent of returning veterans suffer from PTSD and both internal military reports and outside reviews show an insufficient and too-slow response for veterans seeking mental health help. Military spokespeople say they know many returning veteran with mental health concerns who aren’t accessing the help at all. The results of the trials won’t be available for at least a year, but two small pilot studies show a reduction of symptoms by 50 percent in participants just two months after beginning the meditation.
- Read an interview with Jonathan Woodson, MD, assistant secretary for health at the Department of Defense (DOD) on the DOD's emphasis on wellness and suicide prevention.
- Read the full Washington Post article.
- Read a blog post from the Department of Veterans Affairs on maintaining military benefits for veterans displaced by Hurricane Sandy.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. In this Idea Gallery, Jane Isaacs Lowe, Team Director for the Vulnerable Populations Portfolio at the Robert Wood Johnson Foundation, provided her perspective on the critical impact of public policies on the mental health of urban populations.
Recently I attended and spoke at the Social Determinants of Urban Mental Health conference hosted by the Adler School of Professional Psychology. Lynn Todman, the Executive Director of Adler’s Institute on Social Exclusion and the conference’s organizer, has been doing groundbreaking work on the link between public policies and the mental health of urban communities, including the Institute’s Mental Health Impact Assessment, which was developed in part through support from the Robert Wood Johnson Foundation.
It’s been exciting to see the field of health impact assessments grow so rapidly. But, of course, physical health is not the only outcome that matters; equally important is our mental health and its integral connection to physical health, especially for the most vulnerable among us. This is reflected in many of the organizations and models in which we’ve invested and which we’re helping to scale for greater impact. You’ll see it, for instance, in a video we just released on Child First, a psychotherapeutic home-visiting program that works with families with very young children who are showing signs of severe developmental, emotional, and behavioral problems. Child First partners with providers all across the community who touch these families’ lives — including doctors, day care providers, teachers, and social workers. If a provider sees a problem, she makes a referral to Child First, which then arranges a comprehensive assessment and home visit with a team of trained specialists, including a masters-level mental health clinician. That team works on the relationship between the child and parent or caregiver and on environmental factors, such as depression, substance use, domestic violence, food insecurity or homelessness that are detrimental to the child and family.
Ultimately, the goal is to foster strong, stable, nurturing relationships between parents and children and also create a safer and healthier overall environment for the child. In so doing, Child First effectively helps to buffer the developing brains of these young children from the damage caused by repeated exposure to toxic stress, and sets the families on a course toward stability and better health.
As Lynn Todman explains it, effective interventions for addressing the social determinants’ impact on mental health exist along a continuum — from trying to “fix” the individual within the clinical setting to structural reforms that create a social environment that will lead to better mental health outcomes. This is demonstrated in the Child First model, which goes beyond the clinical setting to engage individuals and institutions from across the community united by a common goal. The Adler School wants their students to be able to operate along that continuum, and to understand that, to improve outcomes, change will need to happen outside of the clinical setting, in the context of people’s lives and where they live, learn, work and play. This also must include the realm of policy change. Being able to contribute to this goal was well worth my time.
The other speakers at the conference reflected this belief in the need for interventions along a continuum and which engage individuals and institutions from multiple sectors. Lynn Todman’s background is as an urban planner, which is inherently a multi-disciplinary role. As an urban planner, she needed to understand housing, transportation, social services delivery, fiscal policy, and more. And she needed to be able to apply a lens that allowed her to see the connections between all of these seemingly different issues. It’s worth noting that it’s a lens through which Risa Lavizzo-Mourey is also looking in her recent chapter, “Why Health, Poverty, and Community Development Are Inseparable,” in the book, Investing in What Works for America's Communities. She makes a forceful case that, “community development and health must be partners in planning and building communities.”
We’ve pulled together some of the highlights from the conference, including resources that were shared by speakers. I hope you’ll take a look and, more importantly, put them to use in your own work.
World Suicide Prevention Day, co-sponsored by the World Health Organization, promotes commitment and action to prevent suicides. Almost 3,000 people commit suicide every day, and for every person who completes a suicide, 20 or more may attempt to end their lives. In the first five months of 2012, at least 155 military service members committed suicide—more than the number of service personnel killed in Afghanistan during the same time period.
As part of our National Prevention Strategy series, NewPublicHealth spoke with Jonathan Woodson, MD, Assistant Secretary of Defense for Health Affairs in the Department of Defense, about suicide prevention as well as the department’s overall approach to wellness and prevention for military, veterans and their families.
Listen to the podcast and read the full interview with Dr. Woodson below.
Several mental health organizations and government agencies have announced online or telephone resources to help citizens and professionals cope with worry, fear, anxiety and stress in the aftermath of the Colorado shooting at a movie theater early this morning that has taken at least 12 lives and injured dozens more:
- The Centers for Disease Control and Prevention has a web portal dedicated to disaster response with resources for direct victims and the larger community.
- Mental Health America, a national advocacy and education group on mental health issues, has developed guidelines and a fact sheet to help facilitate discussions about the tragedy.
- The Disaster Distress Helpline (800-985-5990) of the Substance Abuse and Mental Health Administration provides immediate crisis counseling and help to people in the US coping with the shooting incident in Colorado, or any other disaster. The helpline operates 24/7 and connects callers with trained professionals from the closest crisis counseling center in the nationwide network of centers. The helpline can also be accessed by text (Text: TalkWithUs to 66746).
- The Department of Veterans Affairs has a helpful fact sheet on post traumatic stress disorder after a disaster.
- UPDATE: One of our commenters shared resources from the National Child Traumatic Stress Network, which is funded by SAMHSA. See the comment below for more details.
>>Weigh In: Do you have a response system ready for local and national disasters?
The recent spate of severe storms around the country is a driving catalyst behind the decision by the Substance Abuse and Mental Health Administration (SAMHSA) to change the status of its formerly as-needed helpline available after disasters, into a permanent program—the Disaster Distress Helpline.
Brad Stone, a SAMHSA spokesperson, says previously the agency would engage the 24/7 helpline (1-800 985-5990, text 66746) after disasters such as hurricanes to help people in need of mental health counseling and referral. Stone says SAMHSA found the disasters were occurring frequently enough that having it continually available was the best way to help people as soon as a crisis strikes.
The helpline immediately connects callers to trained professionals from the closest crisis counseling center who can provide confidential counseling, referrals and other support services.
“When disaster strikes, people react with increased anxiety, worry and anger. With community and family support, most of us bounce back. Some may need extra assistance to cope with unfolding events and uncertainties,” says SAMHSA Administrator Pamela S. Hyde.
Multilingual help is available and the helpline is intended for anyone experiencing psychological distress as a result of natural or man-made disasters, incidents of mass violence or any other tragedy affecting America's communities.
A recent Reuters in-depth report finds that slashes to state mental health budgets as well as job and home losses from the economic downturn of the last few years have led to an increase in people seeking care for mental illness at emergency rooms. Physicians say the increase has caught them unprepared, with too few social workers to handle cases, too few facilities that can accept patients and ER staff often not trained to handle needs of mental health patients beyond emergency measures.
A veteran commits suicide every 80 minutes, according to reported information from the Department of Veterans Affairs. Unreported deaths may push those numbers even higher.
Foundations and government agencies are addressing the issue through screenings that begin during deployment and with continued follow-up after a service member comes back to the U.S. In observance of Veterans Day, Washington, D.C., talk show host Diane Rehm discussed the issue with experts including Barbara van Dahlen, founder and president of Give an Hour, a non-profit organization that provides free mental health services to veterans and their families, Ranjeev Ramchand of the Center for Military Health Policy Research at the RAND Corporation and Jan Kemp, National Mental Health Program Director for Suicide Prevention, Department of Veterans Affairs.
The show’s website also includes resources that can help prevent suicides among veterans:
- Veterans' Crisis Line: Connects veterans in crisis and their families and friends with qualified responders through a confidential toll-free hotline, online chat, or text message program.
- Give an Hour: Provides free mental health services to U.S. military personnel and their families affected by current conflicts in Afghanistan and Iraq.
- Tragedy Assistance Program for Survivors: Offers support for those grieving the death of a loved one who served in the U.S military.
>>Listen to the program.
>>Read more on military health.
The recent first-ever Centers for Disease Control and Prevention report on mental health issues in America, found that half of all Americans have a mental health issue at some point in their lives. Pamela Hyde, JD, Administrator of the Substance Abuse and Mental Health Administration (SAMHSA) a keynote speaker at this year’s APHA annual meeting, focused on what public health can do to identify these issues and improve prevention, treatment and recovery. Watch her opening session speech here, and read an APHA Q&A with her here.
NewPublicHealth: Your keynote speech at the American Public Health Association annual meeting focused attention on the issues of mental health as a pivotal component of public health. What does the American public need to learn about these issues?
Pamela Hyde: Behavioral health is a major public health issue and we in America don’t tend to look at as a public health issue. We tend to look at it as a social problem. The recent mental health parity legislation, which generally requires that insurance coverage is identical for mental and physical health concerns, helps tremendously in the sense that it makes it very clear that mental health and substance abuse services are just as important as healthcare services and that they should be treated similarly.
We use the term behavioral health because we’re trying to encompass everything from prevention to treatment to recovery and we’re trying to encompass both mental illnesses as well as substance abuse and substance use disorders. Behavioral health is a public health issue, just like diabetes or heart problems or hypertension. There are ways to prevent it and there are ways to treat it and people recover from it.
NPH: What are some of SAMHSA’s biggest recent achievements?
In the U.S., the most recent data show that over 34,000 lives are lost to suicide each year, and over 350,000 people are seen in emergency rooms every year for self-inflicted injuries. To bring attention to this health issue, World Suicide Prevention Day, sponsored by the World Health Organization, is observed each year on September 10.
A recent Centers for Disease Control and Prevention study published in the American Journal of Public Health finds that suicide rates rise and fall with the economy. The study found the strongest association between business cycles and suicide among people in their prime working years—ages 25 to 64.
“Knowing suicides increased during economic recessions and fell during expansions underscores the need for additional suicide prevention measures when the economy weakens," said James Mercy, Ph.D., acting director of CDC's Division of Violence Prevention. "It is an important finding for policy makers and those working to prevent suicide."
Other study findings:
- The overall suicide rate generally rose in recessions like the Great Depression (1929-1933), the end of the New Deal (1937-1938), the Oil Crisis (1973-1975), and the Double-Dip Recession (1980-1982) and fell in expansions like the WWII period (1939-1945) and the longest expansion period (1991-2001) in which the economy experienced fast growth and low unemployment
- The largest increase in the overall suicide rate occurred in the Great Depression (1929-1933)—it surged from 18.0 in 1928 to 22.1 (all-time high) in 1932 (the last full year in the Great Depression)—a record increase of 22.8% in any four-year period in history. It fell to the lowest point in 2000
"Economic problems can impact how people feel about themselves and their futures,” says Feijun Luo, Ph.D., an economist in CDC's Division of Violence Prevention and the study's lead author. "We know suicide is not caused by any one factor – it is often a combination of many that lead to suicide. Prevention strategies can focus on individuals, families, neighborhoods or entire communities to reduce risk factors.”
The American Foundation for Suicide Prevention has a list of evidence-based best practices for suicide prevention.
And last week the Department of Health and Human Services announced $53 million in grants to be administered by the Substance Abuse and Mental Health Services Administration. The grants will be awarded to states and tribes for youth suicide prevention programs.