In an early edition yesterday, labels over two columns of figures were transposed in a graphic about the surgeon general's report on mental illness. The column in which 21 percent had "any disorder" should have been labeled "Age 18-54." (Published 12/15/99)
More than 50 million Americans suffer from some kind of mental illness each year, and many fail to get treatment even though effective therapies are widely available, according to the first surgeon general's report on mental health.
The primary reasons for this failure to find help for their mental illnesses are lingering social stigmas and financial and other barriers, according to the report.
"There's no scientific reason to differentiate between mental health and other kinds of health," Surgeon General David Satcher said at a Washington news conference where the report was formally released. "Mental illnesses are physical illnesses."
Health and Human Services Secretary Donna E. Shalala said the report documented "a public health crisis" in the nation. "The fact is that today mental illness is the second-leading cause of disability, the second-leading cause of premature death in the United States," she said.
The report encourages people with mental disorders to seek help, and Satcher said he supports calls for full "parity" in mental health coverage, saying it is "an affordable and effective objective."
This summer, President Clinton required all federal employee health plans to offer the same coverage for mental disorders as for other illnesses, but negotiations on how to implement that order continue and many other private plans still offer considerably less mental health protection. Congress remains divided on the issue, with opponents saying mental health parity would open employers to large and unpredictable costs.
The report describes the current mental health system as increasingly knowledgeable about how to help people, but increasingly unable to reach many who need help the most. In a preface to the report, Satcher wrote that greater racial, age, gender and cultural disparities exist in mental health delivery than in other areas of medicine and health. The report also notes that per capita spending on mental health in some segments of the private health market is declining much faster than spending on other conditions.
The report is based on a review of more than 3,000 research papers, and on information gathered at the White House Conference on Mental Health in June, chaired by Tipper Gore. She joined Satcher yesterday and called mental illness "the last great stigma of the 20th century."
About 20 percent of Americans are believed to experience a mental disorder each year, according to the report. About 5 percent are severe illnesses such as manic depression, schizophrenia and obsessive-compulsive disorder.
The report is the 51st by a surgeon general--the first was the landmark 1964 report on smoking--but is the first to address mental health, Satcher said. Later in the day, he said he hoped the report would have the lasting impact of the initial report on smoking, but that it would "be more effective than the smoking report in terms of actually changing how people live."
Laurie Flynn, executive director of the National Alliance for the Mentally Ill, praised the report and the surgeon general's willingness to address issues that have been long ignored.
She said, however, that her group, which was actively involved in the June conference, was concerned that the 487-page report addressed too many issues. "We're a little disappointed that the urgent focus on the public health crisis regarding the most serious mental illnesses has gotten lost," she said.
The report is likely to play a role in upcoming congressional debates over various bills to extend insurance coverage to mental health.
"I think it's going to highlight the great disparities regarding mental health treatment, the blatant discrimination that's been taking place," said Rep. Marge Roukema (R-N.J.), the sponsor of a mental health parity bill. "The surgeon general's report . . . also documents the cost-effectiveness of early treatment to help people. This is no longer opinion--this is established fact."
Carmella Bocchino, vice president for medical affairs of the American Association of Health Plans, agreed that the report effectively documented a significant problem that needs to be addressed. But she said the nation needed "an honest debate" about how to implement and pay for improvements to mental health coverage.
"We've seen estimates that mental health parity would require cost increases of 1 to 5 percent," she said. "So there will be trade-offs here. Do we give up other parts of the benefits package, or are we looking to rising health care costs?"
In 1997, Congress passed a law that required equal lifetime coverage for mental health and physical health costs. But mental health advocates maintain that legislation was inadequate--allowing much bigger co-payments for mental health treatment and tight limits on treatment. California recently became the 28th state to pass mental health parity legislation.
While Gore, Satcher and Shalala consistently spoke yesterday about the effectiveness of current treatments--and expectations for new breakthroughs--the full report is more nuanced about the realities of psychiatric medications and therapies.
It points out, for instance, that 30 percent to 50 percent of patients do not respond to initial medications they are prescribed. It also reports that while 50 percent of patients with major depression respond successfully to the newer anti-depressants like Prozac and Zoloft, 32 percent also respond successfully to a placebo.
The report also wades into numerous controversies over treatments. In a generally positive assessment of electroshock therapy--which induces brief seizures by passing an electric current through the brain--the report concludes: "On balance, the evidence supports the conclusion that modern [electroshock] is among those treatments effective for the treatment of select severe mental disorders."
Regarding the increasingly popular herbal remedy St. John's Wort, which is used to treat depression, the report concludes that the publicity surrounding the product "is well ahead of the science database supporting the effectiveness of this putative antidepressant."
From the Report
A surgeon general's report states that about one in five people suffer from some form of mental illness.
Percent who suffered from a mental disorder in the past year.
Age 18-54 Age 55+
Any anxiety disorder 16.4% 11.4%
Simple phobia 8.3 7.3
Social phobia 2.0 1.0
Agoraphobia 4.9 4.1
Panic disorder 1.6 0.5
Obsessive complusive disorder 2.4 1.5
Any mood disorder 7.1 4.4
Major depressive episode 6.5 3.8
Unipolar major depression 5.3 3.7
Dysthymia (long-term depression) 1.6 1.6
Bipolar I 1.1 0.2
Bipolar II 0.6 0.1
Schizophrenia 1.3 0.6
Psychosomatic disorder 0.2 0.3
Antisocial personality disorder 2.1 0
Anorexia nervosa 2.1 0
Severe cognitive impairment 1.2 6.6
Any disorder 21.0 19.8
Anxiety disorders 13.0%
Mood disorders 6.2
Disruptive disorders 10.3
Substance use 2.0
Any disorder 20.9
Tens of billions of dollars are spent on mental health each year.
In billions, 1996
Mental disorders: $69 billion
Alzheimer's/dementia: $18 billion
Addictive disorders: $13 billion
Depresssion is the second leading disease in terms of total years of healthy life lost.
Leading sources of disease burden (total years of healthy life lost) in established market economies:
1. Ischemic heart disease
2. Unipolar major depression
3. Cardiovascular disease
5. Road traffic accidents
Newer antidepressant drugs are effective treatments for major depression.
Response to medication 50%
Percent response to placebo 32%
Dysthymia (Long-term depression)
Response to medication 59%
Response to placebo 37%
Suicide has dropped overall but still remains higher than the homicide rate.
Suicide in America
31,000 Suicides annually.*
500,000 People visit emergency rooms because of attempted suicide annually.*
Suicide rate (Per 100,000)
Suicide rate in adolescents and young adults has almost tripled since 1952.
Suicide rate is 50 percent higher than the homicide rate.