LIVING WITH MENTAL ILLNESS

December 13, 1999
		One American in five suffers from a mental disorder in any given year, but two-thirds do not seek treatment because of shame or cost of care. After a background report by Susan Dentzer, Surgeon General David Satcher talks about the the report he presented today at the White House. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

June 7, 1999: The White House conference on mental health Forum: Health Insurance and Mental Illness January 1999: Freud's Legacy Sept. 8, 1998: Treating Schizophrenia July 27, 1998: A schizophrenic man opens fire at the Capitol. Dec. 23, 1997: Many homeless people suffer from mental illness May 9, 1996: Health insurance for mental health Complete NewsHour coverage of health.   Mental Health: A Report of the Surgeon General The Surgeon General National Institute of Mental Health (NIMH) National Alliance for the Mentally Ill	SUSAN DENTZER: The 487-page document released today is the first surgeon general's report ever on mental illness. As with the first surgeon general's report, the famed 1964 warning on the dangers of smoking, this report summarized top scientific research to underscore a major health problem. Health and Human Services Secretary Donna Shalala: DONNA SHALALA: At a time when treatments have never been more safer or more effective, too many people are avoiding those treatments. Our message is simple: Mental health is fundamental to public health. SUSAN DENTZER: The report paints a picture of a nation facing a heavy burden of illness, from major depression to schizophrenia. It noted that one in five Americans has a mental disorder in the course of a year, a proportion that also holds for children and adolescents. One in seven adults uses mental health services annually, at a cost that totaled nearly $100 billion in 1996. Laurie Flynn heads the National Alliance for the Mentally Ill, a leading advocacy group; she said the report shows more must be done. LAURIE FLYNN: Half of everyone with a serious mental illness is not getting any treatment. Forty percent of the homeless have mental illness, and about 20 percent of people in jails and prisons have a serious mental disorder. SUSAN DENTZER: A key reason is a massive shortage of community-based services for the mentally ill. Tipper Gore, wife of Vice President Al Gore and a mental health care advocate, had urged the surgeon general to undertake the study. TIPPER GORE: Mental illness is still very much feared, and it's very much misunderstood in far too many communities around this country. And one of the greatest things we can do is erase the stigma. SUSAN DENTZER: And the report said that should be possible now that there is proof that these so-called "mental conditions" have physical causes, and that they often respond better to treatment than do conditions like heart disease. Citing those findings, mental health advocates praised the report's call to equalize health insurance coverage for both mental and physical illness.
	Science shows mental illness can be treated
	GWEN IFILL: And with me is Dr. David Satcher, surgeon general of the United States. He released today's report. Dr. Satcher, mental illness is not like tobacco. It's not something you can stick a warning label on and warn people to do a certain set of things. So what is it that your report hopes to do? DR. DAVID SATCHER: Well, number one, we hope to use the science. I think there's been a virtual revolution in the science of mental illness over the last 25 years, and using that science, we hope to make the point that mental illnesses are real. They have real physical, chemical bases. There's no longer justification for distinguishing between mental and physical illnesses because there are physical, chemical bases for mental illnesses. We hope that will help to change the stigma that so often surrounds mental illness and therefore make it easier for people to seek treatment. The other thing that the report, the science shows, is that we can treat, we can effectively treat mental illnesses. The overwhelming majority of people with mental illnesses can be effectively treated and return to productive lives and positive relationships. And so we can remove the barrier of the stigma, we believe we can make a major difference. We urge people who have mental illnesses -- or who think they do -- to seek diagnosis and treatment. The bad news in the report, as pointed out, is that even though one in five persons in this country suffer a mental illness each year, less than half will seek treatment. And so that's the bad news. And we hope to change that.
	Report geared to the American population
	GWEN IFILL: So who are you targeting these findings to, the health care community, to government, or, as you mentioned, to individuals that need to get over the stigma associated with the illness? DR. DAVID SATCHER: I think first and foremost we're targeting this report to the American people, because we really need the change the environment. Australia, for example, went through a very comprehensive strategy for destigmatizing mental illness, and we're trying to do that. That's our first charge, is to really see if we can change the environment so that people feel comfortable. I mean, if a person has a cardiovascular disease or diabetes, they're not embarrassed to seek care, but so often in this country if people have mental illness, they're embarrassed. Families are embarrassed. You can't change that unless you change the level of awareness of the American people and change the attitudes of the American people. So the report is geared toward the American population, but it's also, as you imply, geared toward the people who need to seek treatment and are not seeking it. GWEN IFILL: As we just saw in Susan Dentzer's report, nearly half of the people who suffer from severe mental illness do not seek treatment. DR. DAVID SATCHER: That's right. GWEN IFILL: It's got to be about more than embarrassment. DR. DAVID SATCHER: It is. I think stigma is a barrier to seeking treatment, but we also should admit that for many people who seek treatment, they find difficulty getting the access to services they need. That's in part related to the fact that we actually discriminate in terms of providing services. GWEN IFILL: In what way? DR. DAVID SATCHER: We don't provide parity of services for mental illness. There are many health insurance plans who will not cover mental illnesses to the same extent that they cover other illnesses. GWEN IFILL: So if an employee has heart disease, that employee is more likely to be covered for treatment than for any kind of mental illness? DR. DAVID SATCHER: Most definitely. Right. Most definitely. Now, it's interesting that 27 states have now passed laws providing parity. All of those laws are not equal, but it is encouraging that 27 states have now said that if you're going to practice your insurance in this state, you have to provide parity of access to an extent. President Clinton at the White House conference on mental health said that from now on any health plan that provided coverage to federal employees would have to provide parity of access. That's progress, and we need to keep it going. And that's the goal of this report, as you implied, not only to get rid of the stigma, but also to begin the change the system so that we remove the barriers to access.
	Mental illnesses and disorders differ
	GWEN IFILL: Isn't part of this, Dr. Satcher, also a matter of definition? Many people don't recognize what depression is. Older people are more likely to seem depressed because of bereavement, but bereavement in and of itself may not be clinical depression. DR. DAVID SATCHER: Yeah. I think the first question is what is mental illness. And we have defined mental illness in this report as an alteration in thinking or mood or behavior or some combination of those that either creates distress or interferes with one's ability to be productive or one's relationships. That's mental illness. Now, there are a lot of different categories of mental illnesses. There are anxiety, depression -- GWEN IFILL: You make a distinction between mental illness and mental disorders. DR. DAVID SATCHER: Yeah. Well, the big distinction, though, is between mental health problems -- because mental disorders are diagnosable mental illnesses -- that's how we define mental disorders. But when you were talking about the bereavement, that's a mental health problem but not a mental disorder or mental illness. I think that's a very important distinction. You can lose a loved one and you can be depressed for a month-and-a-half and not have a mental illness. But if that depression goes on for four to six months, you are likely to have a mental illness and you need to be seen and treated. GWEN IFILL: It's one thing to say, let's remove the stigma from mental illness, but how do you devise a social, moral, political construct that does that? DR. DAVID SATCHER: Well, I think what should do it is the science. Now, I think the reason there's so much stigma surrounding mental illness is, one, we've had questions about whether they were real. There are a lot of people who just don't believe that mental illnesses are real. There are other people who believe they are character disorders or spiritual disorders. And let me say that this report shows the science that says that the bases of mental illness are chemical changes in the brain and, therefore physical changes, changes in the basic cells of the brain. That's why I hold that there's no longer any justification for the distinction that we've made between "mind and body" or "mental and physical illnesses." Mental illnesses are physical illnesses. They're related to physical changes in the brain. GWEN IFILL: It seems we have the greatest trouble dealing with a mental illness at the beginning of life and the end of life -- children overlooked, older people overlooked. How do you begin to address that? DR. DAVID SATCHER: This report takes a life cycle approach to the subject of mental health and mental illness. There's a chapter on childhood and adolescent problems. There's a chapter on adults. Then there's a chapter on older Americans. As you point out, older Americans perhaps suffer disproportionately, certainly dementias like Alzheimer's disease as we see in people generally who are older, and with the population increasingly aging, we're going to see more disability from mental illnesses. Now, I want to make it very clear that some people expect that it's normal for older people to be depressed. It is not normal. And we ought to take the attitude that clinical depression in older people needs to be diagnosed and treated. And that's what we're urging, to make people much more functional and certainly much more comfortable in their day-to-day lives. GWEN IFILL: If health insurers were to begin to extend coverage to people for mental illness treatment as much as they do for other kinds of illness, how much would that cost? DR. DAVID SATCHER: You know, we don't know. We spend about $100 billion a year treating mental illnesses. And that includes Alzheimer's and that includes addictive disorders. Let me tell you what we do know -- that there are health plans in this country that have now expanded their programs to provide parity of access for mental illnesses. And what they have found in these plans is that the difference in costs is like 1 to 2 percent in either direction. They have plans that argue that since they are offering parity of access for mental illness, their costs have gone down. Now, that's pretty difficult to understand. And I want to try to explain it. Let me say that there are many people in this country who are suffering from depression who go to the physicians and complain of headaches and low back pain. They don't complain about depression. There are many people who have other problems that affect their health, and they complain about them, but they don't go and say I have anxiety or depression. So I imagine that has something do with it. We believe that mental illnesses -- even though not being treated -- have a major impact on the health care system.
	Targeting overlooked populations
	GWEN IFILL: What happens to the people who are left untreated, the people who cannot get over the stigma, or the people who don't even realize that they are ill? Where do they go? DR. DAVID SATCHER: All of the indications that we, America, to a great extent are dumping our mental health problems on the streets of America where one-third to one half of homeless people are suffering from mental illnesses and for the most part are not being treated. We're also dumping them in our jails and prisons where 15 to 20 percent of people in jails and prisons are mentally ill and often not being treated. It's very unfortunate. We're criminalizing mental illness. And that needs to change. And I hope this report will be a major step in that direction. Unfortunately, I think that's what's happening in many cases to our mental health problems. GWEN IFILL: When the surgeon general issues a report, we expect a call to action. What is your call to action? DR. DAVID SATCHER: Yes. Well, there are several areas that we feel that we need action. Number one is to really move forward with this destigmatization campaign aggressively, and we plan to do that. And we just visited Australia to look at what they have done. And we were impressed. We need to continue to research. I want to make it very clear that despite all the science we've had over the last 25 years, we need more research and treatment, but especially in prevention. Unfortunately, as much as I care about prevention, this report doesn't say much about prevention because we don't know a lot about prevention. GWEN IFILL: Right. DR. DAVID SATCHER: We know more about mental illness than we do about mental health, unfortunately. We need to know more about how to promote mental health and how to prevent mental illness. And we need more research. And we're going to push for that. We also need to move forward with improving the system of treatment, improving access, better job at training health providers, not just psychiatrists and psychologists, but family physicians, internists, pediatricians to diagnose and treat mental illness. But we also need a community-based approach. We need homes and schools and churches and businesses to become involved because it is, for example, in schools that mental health problems often first play out or in the home. And we want a comprehensive community-based system for dealing with mental health problems. GWEN IFILL: A very difficult and complicated issue. Thank you so much for helping us with it, Dr. Satcher. DR. DAVID SATCHER: Well, thank you. I'm delighted to be here.