Mental Illness is the Leading Cause of Disability

You might think mental illness (MI) affects only a small few–but you’d be thinking wrong.

According to Kessler et al in the “Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication,” published in 2005, 26.2% of Americans 18 and older–that’s about one in four adults [they did the math for me, so I’m pretty sure it’s right]–suffer from a mental disorder in any 12-month period. However, the Center for Disease Control estimates that “about half” of U.S. adults will develop a mental disorder. I say we hold by Kessler, shall we? Both agree that suicide is the 10th leading cause of death in the U.S.

Meanwhile, one in 17 (that’s about 13.6 million) Americans live with what’s known as “serious mental illness” (they even have their own acronym: SMI), which includes major depression, schizophrenia, or bipolar disorder.  SMI is defined by federal legislation as a mental disorder that substantially interferes with life activities and ability to function.

While everyone seems to know about the debilitating effects of cancer, multiple sclerosis, or AIDS, few are aware that, according to the National Institute of Mental Health, mental disorders are the leading cause of disability in the U.S. and Canada.

Looking outside ourselves for a moment, the statistics are virtually the same, with the World Health  Organization (WHO) estimating 1 in every 4 people worldwide will develop one or more mental disorders at some point in life.  As of 2010 that’s a staggering number– 450 million people.

It’s hard to get your head around a number like that;  it means that mental illnesses are more common than cancer, diabetes or heart disease.

Yet treatment is much vastly more inadequate. In fact, there is a general inequity in treatment resources between wealthy and impoverished countries when it comes to mental health. WHO points out that in low-income countries there are 0.05 psychiatrists and 0.42 nurses per 100,000 people.  I know, it’s very hard to get your around that. I’m trying to picture 5-hundredths of my own psychiatrist arguing with me about my weekly blood-tests.  Surely I would win in that case?  In high-income countries, the rate is 170 times greater for psychiatrists and 70 times greater for nurses.

However, these higher percentages in wealthy countries isn’t worth much. Wang et al (2002) estimates that every year in the U.S. 8.5 million people with SMI fail to receive what the researchers term “minimally adequate treatment” (and they really do mean minimally*) with standards usually established by the American Psychiatric Association.

Availability for treatment of children is staggeringly less adequate. Both in the US and around the world, half of all mental illnesses begin before the age of 14. Yet, notes WHO, the majority of low- and middle–income countries have–get ready for this–one child psychiatrist for every 1 to 4 million people. Just think what they could charge Medicare!

Okay–so what to do?

The National Alliance of Mental Health (NAMI) is a start. (NAMI is the country’s biggest mental health organization. It advocates at all levels of government, supports research–and is just there for the mentally ill.  Check out their site for Mental Illness Awareness Week 2013.)

When they say “write a Letter to the Editor,” NAMI provides you with the entire structure for that endeavor–and practically every line as well.  Your biggest job is remembering how to sign your name. [See Model letter to the editor.]  Same with the Op-Ed, except they ask even less of you [Model op-ed]. (Truthfully, I exaggerate a little.  For each of the previous, NAMI requests that you put in a personal anecdote.  It doesn’t seem too much to ask, given all they’ve provided.)

Then–no fools they–they provide a link to their store, where you can buy anything from a Mental Health Care Gets My Vote! Bumper Sticker to A Family Guide: What Families Need to Know About Adolescent Depression to a Famous People Poster (which, to be honest, struck me as fairly random. It includes Abraham Lincoln, Beethoven and Charles Dickens–right alongside Carrie Fisher and Patty Duke).

Look-you may very well not want one of these, but some people’s greatest contribution to causes is spending money, and if that’s you, you’ve got to go with what they’ve got–maybe even buying your own copy of A Mental Health Recovery and Community Integration Guide for GLBTQI Individuals: What You Need to Know.

AND–did you think I would ignore this?–this is also the week where you need to take the crucial step of either getting yourself screened for depression, or firmly encouraging someone near you to do so.

In 2007, just under 3 out of every 100 people in the US were treated for depression. That would be just fine–but the CDC reported that 1 in 10 adults are actually depressed.

Simply determined you won’t be seen in any mental health practitioner’s office?  Okay–you win (I really don’t know what)–but there are online screenings.

Pick a reliable site, like, Psych Central, which has an 18-question quiz it asks you to take weekly, or Mayo Clinic, which has its own Depression self-assessment.  Better yet– since it’ll actually mean something to your doctor, should you ever get in to see one–choose the Depression and Bipolar Support Alliance. This professional level inventory uses a standardized diagnostic test, known, as they all are, in letter gibberish as the QIDS-SR, which means (guesses here-anyone?): the Quick Inventory of Depressive Symptomatology Self-Report (any winners?).


Back to those NAMI Op-eds and Letters to the Editor–and their requests for personal anecdotes.

If MI statistics don’t move you, perhaps just a word or two from your local sponsors, or someone who’s been through it, might mean more. We owe it to the mentally ill to make sure they have access to good health care and strong advocacy groups, not just because it’s ‘the right thing to do,’ but because MI could strike one of us, at any point in time. My motif: You think it can’t–but it can.

I know the following to be true, from first-hand experience, and I assure you, although you may feel confident it could never happen to you, the statistics and I think you might be wrong:

  • MI can sneak up on you, insidiously making its way into your life to the point that it feels unmanageable, You sense it’s coming, you don’t feel well, something’s wrong, your parent, friend, spouse has urged you to see a therapist for months.  If you don’t take care of it–I mean, really treat it–you may soon be sicker than you could have ever imagined.
  • You think you are fully independent.  You work, you live alone, you run your own life. MI can take that all away from you inexorably.
  • You have a job, a career, really. You earn a living, and are well thought-of.  You think that because that is true today it will be true tomorrow and next month, year, decade…. MI isn’t interested in your career plans. Just as food for thought: I was a well-respected English teacher, for 10 years, and I pulled my students through those classics, sometimes kicking and screaming. (If I only knew then that I’d actually be heading down that “Road Not Taken”–and wouldn’t recommend it to my worst enemy.) Now, after months of the whole sickness thing–hospitalizations, ECTs,  multiples of med trials–I’m able to go back into the school where I once did that teaching–as an aide to my sister, who’s the assistant principal. It is a tremendous step, and I’m grateful. But I’ll give you 3 spins of the wheel to guess what I do there.  Give up? Yesterday I passed out Clorox wipes; the week before I did Kleenex boxes.
  • Think you’ll never move back home? Couldn’t possibly stand living with your sister-in-law, let alone your mother, Heaven forfend? Wait until your depression is so bad you can’t get out of bed to bathe, couldn’t possibly make it to the store to get food, and you wake up in the morning so afraid of the day that you scream out for someone–anyone–to come.  Mom and sis start to look pretty good in the face of outright terror and self-neglect.
  • Time betrays you.  You’ve spent your whole life feeling they’re just aren’t enough hours in the day. And then, suddenly, you feel like you’re swimming through a molasses of minutes. You find yourself gripped by an unnameable fear, counting the seconds, clutching your covers, convinced you won’t make it through to the moment when you can just sleep again.  But you’re afraid even of sleep, with its blessed release, because sleeping means waking up to do it another day.
  • Have you always been, deep down, a little vain about your looks?  Between the gym, your hairdresser, and some quality makeup, have people always taken you for younger?  Well one class of meds puts 25 pounds on you in a month for starters, while another makes your hair fall out in chunks. You’ll need a new cover for your shower drain–and your doctor will teach you how to monitor your new-found diabetes. There are plenty of places to donate your size twos–and fours, and sixes, and eights. . .
  • Always been pretty swift? Did well in school, had a hot-shot career? Real MI is going to surely rock that boat. Aside from the leave-of-absence (end-date unknown) you’ll be taking anyway, SMI comes all wrapped up–just like a Christmas gift–with cognitive impairment.  That’s without ECT (see below). So you can spend some of your endless hours re-learning skills you had mastered by adolescence: practicing reading advanced texts, depending on your GPS for the routs to your brother’s house, or re-teaching yourself how to use your iPhone, even though you used to be an Apple whiz.
  • Remember that scene from “One Flew Over the Cuckoo’s Nest,” the one that makes you want to sign right up for electroconvulsive shock therapy (ECT)?  I know, I know: You say to yourself now that you would never undergo such a treatment (even though it’s nothing like the movie).  But the truth is: you cannot imagine what you will do to try to relieve a depression so crippling that life has become a morass of minutes. You just might find yourself begging for it.
  • And then you may not realize quite how unique suffering from MI is–until you to want to reach out to others, and they, simply put, don’t want to hear about it. When they ask, “Hey, where you been these past two months,” I assure you they do not want to hear, “Oh, I was locked up in a hospital where I stayed in bed all day except when it was time to wait in the med line–oh, and except for the days when they took me to the OR on a gurney to force a grand mal seizure. That’s pretty much it–how ’bout you?” In fact, you may never be able to tell some of your friends about your experience with MI. [Interestingly, the CDC ran a study in 35 states + DC and found that 22.3% of those interviewed believed “people are caring and sympathetic to persons with mental illness.”]

So that’s it. I was no different from you. But things can change, and mental illness is non-discriminatory. It also gets worse without treatment, increasing damage to the brain with multiple episodes.  But here in this country, approximately 60% of adults and almost 50% of children ages 8-15 suffering from MI received no services in 2012.

So sign a petition to Congress or a Pledge for Wellness–take for yourself or get a friend or family member in for a Depression Screening. Maybe let a friend who’s been through the ringer with MI finally talk about it. Just do something. Because it’s awful–and because it could happen to you.

[*According to the NIMH “minimally adequate treatment for major depressive disorder (MDD)” is either 4+ outpatient visits with any kind of medical doctor plus a prescription for an antidepressant or mood stabilizer for at least 30 days; OR 8+ psychotherapy sessions lasting at least 30 minutes each.  This does, indeed, strike me as minimal, although not, perhaps, as adequate.]

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