We’re Number 1…in Mental Illness?!

June 10th, 2005 by

The National Institute of Mental Health recently issued the findings of its $20 million study of mental health in the United States. Parallel studies are taking place in 27 other countries, but even though these studies have not yet been completed, the National Institute of Mental Health is ready to declare us the winners. “We lead the world in a lot of good things, but we’re also leaders in this one particular domain that we’d rather not be,” said Ronald Kessler, the Harvard professor of health care policy who led the effort, called the National Comorbidity Survey Replication (PDFs here).
News Coverage
I am as fascinated by the way the study is being presented in the media as by the study itself. Just take a look at some of the headlines gleaned from newspapers and the internet:
“U.S. Leads in Mental Illness” (Washington Post)
“U.S. Mental Health Holding Steady”(Science Now)
“U.S. Mental Survey Depresses Experts” (Nature.com)
“Mental Disorders Strike Nearly Half of All Americans”
“Little Change in Suicidal Thoughts or plans in U.S. ” (Medical News Today)
And the winner is:
“Survey Says Person Next to You is Nuts” (Web Pro News)
The study involved face to face interviews with over 9,000 individuals. The surveyers were carefully trained. The questionnaires were detailed and comprehensive. I am not sure how you can extrapolate the mental health condition of 296 million people by surveying .00003 percent of them, but I’m neither a mathematician nor a mental health expert, which is probably just as well.
The study found that less than half of those in need of mental health services get treated. Those who seek treatment typically do so after a decade or more of delays, during which time they are likely to develop additional problems. And the treatment they receive is usually inadequate. The study projects that almost half of Americans (about 145 million people) meet the criteria for illness at some point in their lives, but acknowledges that most cases are mild and do not require formal treatment. Every year about 6 percent of adults are so seriously affected that they cannot perform even routine activities for periods averaging three months.
The report speculates that this lack of appropriate intervention results from a number of causes, including the failure to recognize early warning signs, inadequate health insurance (I would add, routine exclusion of mental health services by health insurers) and the lingering stigma that surrounds mental illness. Indeed, once people are perceived as having a mental problem, they may not be able to escape being seen in that light.
Thomas Insel, chief of the National Institute of Mental Health, said the nation needs to recognize that mental illness is a chronic condition that requires expert medical attention just as heart disease, Alzheimer’s and diabetes do. Intel was disappointed to learn from the survey that despite the availability of effective treatments for many mental illnesses, about a third of people in need rely solely on nonprofessional sources such as Internet support groups and spiritual advisers.
“You wouldn’t rely on your priest for treatment if you had breast cancer,” Insel said. “Why would you go to your priest for a major depressive disorder? These are real medical and brain disorders, and they need to be treated that way.” [Disclaimer: reading the Insider will do nothing for depression and may on certain days actually increase anxiety.]
Implications for the Workplace
The study does not attempt to project the number of American workers trying to perform their jobs while suffering from mental disorders. But if nearly half the population has a problem at some point in their lives, then the workplace must be pretty well saturated with potential issues. We have a long way to go in recognizing how mental health impacts job performance and in developing meaningful interventions. When you’re Number One, it’s lonely — and sometimes even dangerous — at the top.