Mental Illness and National Policy
White, Stephen W., National Forum
In his foreword to the 1991 book Psychiatric Disorders in America, by Lee Robins and Darrel Regier, Daniel X. Freedman writes:
Less than a month after President Carter's 1977 inauguration, Rosalynn Carter was authorized to assemble a commission to examine the nation's needs for mental health services and new knowledge about disorders. Sitting with her in a basement office of the White House East Wing as the initial plans were made, one could not mistake Mrs. Carter's clear respect for and interest in sound information. Her questions were unerringly straightforward. How many are suffering from these illnesses, who are they, and how are they treated? Embarrassingly, equally straightforward answers could not be provided. The base of information about the scope and boundaries of mental illnesses was simply inadequate. Fifteen months later her commission had sparked a remarkable decade-long journey to this singular volume.
What Lee Robins and Darrel Regier discovered is disconcerting. Put bluntly, the authors report that "The figures of a 32 percent lifetime and 20 percent annual prevalence are the best current estimates of the prevalence of psychiatric disorder in America." |Follow-up estimates of prevalence rates are even higher. In a later article published in Archives of General Psychiatry (February 1993), Regier et al. note a 28.1 percent annual prevalence rate for mental and addictive disorders (44.7 million adults) or 22.1 percent annual prevalence rate for mental disorders alone (35.1 million adults).~ These estimates are based on conclusions drawn from a decade-long study of mental illness in a designated ECA (Epidemiologic Catchment Area) covering five sites in New Haven, Baltimore, St. Louis, Durham, and Los Angeles. The good news about these figures is that they represent the entire spectrum of psychiatric disorder, not just severe mental illness. The bad news is that the magnitude of the numbers indicates a significant national crisis in mental health care, for we know that if the current population of the United States is 252 million (1991), then there are perhaps 50 million people with psychiatric disorders. And as we approach questions about reforming the health care system in the U.S., we know that the populations most likely to be overlooked will be those with mental illness, mental retardation, rare genetic disorders, etc.--in short, those with special needs.
A quick mathematical calculation would reveal that, in the area of psychiatric disorder alone, over 75 million people will be at some point in their lives affected directly by reform in mental health care (given a 32 percent lifetime prevalence rate for mental illness). And many more (friends and relatives) are potentially concerned that the structure for health care reform be carefully planned to ensure health coverage for the mentally ill. But before this nation will act collectively to do anything about its mentally ill, citizens will first have to be convinced that there is indeed a crisis. And there is.
Speaking before a conference of the National Alliance for Research on Schizophrenia and Depression (NARSAD) in Atlanta, Georgia, in 1992, Dr. Charles B. Nemeroff--the chairman of the Department of Psychiatry at the Emory University School of Medicine--called attention to a number of dramatic facts to underscore the potentially costly nature of untreated mental illness. Citing data from the American Suicide Foundation, Dr. Nemeroff pointed out that over 30,000 people in America killed themselves in 1991. This is a national tragedy. And over one-half million people attempt suicide every year (see data on p. 28). To put this in context, Dr. Nemeroff poignantly added that almost as many people in the United States die in a two-year period from suicide (60,000) as died during the entire Vietnam conflict (47,355 battle deaths, 67,008 total war-related deaths). His citing these statistics made me ponder how different our responses have been to the two national crises of war and suicide. …