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Mental Illness

Very common but often goes untreated

Karen Miller
Mental Illness

The general public’s perception of mental illness is more often influenced by its portrayal in the movies than by fact. In reality you sit beside people with mental health disorders on the bus and you work with them. Just as you cannot detect who has diabetes or high blood pressure, for the most part, you cannot detect who has a mental illness.

That’s because when diagnosed many mental health conditions can be successfully treated.

»Types of mental illnesses

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is used by mental health professionals to diagnose and classify mental disorders. It consists of dozens of psychiatric disorders. Some disorders have subcategories, which have subcategories of their own. The list below is a brief summary of common disorders.

Attention deficit hyperactivity disorder (ADHD): Difficulty staying focused and paying attention; more common in childhood, but may continue into adulthood.

Anxiety disorders: Characterized by excessive worry and fear, panic attacks and phobias

Autism: Developmental disorder that disrupts the ability to socialize or interact with others

Bipolar disorder: Characterized by mood swings, shifting from depression to mania or hypomania

Borderline personality: Difficulties in regulating emotions; includes a pattern of unstable relationships, distorted self-image and impulsiveness.

Depression: Persistent feelings of sadness, worthlessness and hopelessness

Dissociative disorders: Characterized by a disconnection between thoughts, identity and memory; can include amnesia and alternate personalities

Obsessive-compulsive disorder: Characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform

Post traumatic stress disorder: Intrusive memories of a traumatic event; avoidance of activities related to the trauma

Schizophrenia: Serious mental illness that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others

For more detailed information visit the National Institute of Mental Health at www.nimh.gov.

Mental illness carries an air of mystery. That’s understandable. It’s a disease of the brain, which is a complex, sophisticated organ that controls almost every aspect of the human body. The brain not only enables us to think, remember and breathe but it also controls our emotions and behavior. It makes up only two percent of our body weight but consumes 20 percent of the energy we use — it is constantly working. President Barack Obama in 2013 developed The Brain Initiative to help solve and understand its mysteries.

Sometimes the communication system in the brain goes a little awry. Chemicals called neurotransmitters may not function as well as they should and prevent messages from getting through. It is this malfunction that can lead to certain forms of mental illnesses. For instance, as noted by the National Institute of Mental Health, low amounts of the chemical serotonin can lead to depression; an inadequate supply of glutamate, the most common neurotransmitter, is linked to depression, schizophrenia and obsessive compulsive disorder, or OCD. Medications help restore the balance.

Mental disorders can also result from trauma or other environmental stimuli. Some disorders are genetically linked, particularly schizophrenia and bipolar disorders.

When mental health symptoms interfere with daily living it’s advisable to talk with your primary care physician. Chances are they won’t subside on their own. Symptoms vary by the disorder, but Dr. Morgan Medlock, a psychiatrist at McLean Hospital, explained that there are some tell-tale signs regardless of the exact illness. “There’s a social aspect of mental instability,” she said. “A person may no longer interact at school or church and becomes withdrawn. If a person’s social functioning changes, that’s a strong indicator.”

»Types of mental health providers

There’s a common misperception that mental health services fall under the purview of psychiatrists. Not so — and that might be a good thing. According to the most recent report from the U.S. Bureau of Labor Statistics, psychiatrists number roughly 25,000 — too few to tend to all those in need. In comparison, licensed clinical social workers, who provide the bulk of mental health care in some settings, add 200,000 to the pool.

There are several other types of mental health professionals, but may differ in the level of services offered or licensure to prescribe and dispense medication. In addition, some providers specialize in treating certain mental health conditions, such as bipolar disorder or schizophrenia. These factors should be considered when choosing a provider.

Mental health providers that can prescribe medication:

Psychiatrists are medical doctors (M.D.) or doctors of osteopathy (D.O.) that specialize in the diagnosis and treatment of mental health disorders. Some psychiatrists, however, only prescribe medication and do not counsel patients.

Psychiatric mental health nurse practitioners (P.M.H.N.) are registered nurses with training in mental health.

Certified physician assistants (P.A.-C.) practice medicine under the supervision of physicians and can specialize in psychiatry.

Mental health providers that cannot prescribe medication:

Psychologists hold a doctoral degree (Ph.D., Psy.D., Ed.D) in psychology and are trained to make diagnoses and provide individual and group therapy.

Licensed clinical social workers (L.C.S.W.) hold a master’s or doctoral degree in social work and are trained to provide assessment and counseling.

Licensed professional counselors (L.P.C.) are trained to provide diagnoses and psychotherapy. Training varies by state, but most have at least a master’s degree.

Several other providers, such as marital and family therapists, certified alcohol and drug abuse counselors are available. Credentials may vary by state.

The economic impact of mental illness is huge. The April 2015 Medical Expenditure Survey noted that at $51.1 billion, mental disorders were the third most costly medical expenditures for adults between 18 and 64 in the U.S. in 2012.They trailed only traumatic-related disorders and cancer. Almost half the expenditures were due to prescribed medications.

These figures correspond to the volume of patients. Approximately 45 million or almost 20 percent of U.S. adults experience a mental illness in a given year, as noted by the National Association of Mental Illness, or NAMI. In comparison only 14 million people are living with cancer and 29 million have diabetes.

Yet, as common as these illnesses are, nearly 60 percent of adults with a mental illness fail to receive treatment in a given year. For many reasons. One is lack of availability of mental health services and providers. A report published by Mental Health America — Parity or Disparity: The State of Mental Health in America 2015 — showed a wide difference among states in prevalence of mental illness as well as access to care. For instance, while Massachusetts has one mental health provider for every 248 residents, Alabama has one provider for every 1,827 residents.

Availability of health insurance is another factor. Since the passage of the Affordable Care Act, commonly referred to as Obamacare, only 12 percent of people in this country lack health insurance, according to the most recent Gallup report. The ACA’s impact on coverage for mental health services, however, is not universal and can vary from state to state.

African Americans and other minorities are less represented in the patient pool of mental health services. Only one-third of African Americans who need such care receive them, according to the American Psychiatric Association. In addition, blacks are more likely to stop treatment early and less likely to receive follow-up care.

Yet, the daily challenges of many people of color — poverty, low education, discrimination — can cause undue stress, depression and anxiety. Dr. Chester M. Pearce, a black psychiatrist affiliated with Massachusetts General Hospital, coined the phrase “microaggressions” in 1970 to mean unintended discrimination. These subtle forms of racism can accumulate and result in a toxic stress response.

The American Psychiatric Association agrees. In 2006 the organization took the position to recognize that racism and racial discrimination can adversely affect mental health.

Stigma

The stigma of a mental health illness looms large among blacks. There is a fear of being considered “crazy” or hospitalized or reluctance to “air their dirty laundry.” Some are too embarrassed to receive care or think that treatment will not be effective. Or they may not be aware that the symptoms require treatment.

Blacks might feel uncomfortable discussing their problems with people of another race for fear they will not be understood or misdiagnosed. NAMI reported that African American men are more likely to receive a misdiagnosis of schizophrenia when expressing symptoms related to mood disorders or PTSD. Medlock agreed. “There’s an over-

diagnosis of schizophrenia and psychosis among blacks,” she explained.

Loss of control is another fear. “The mind is one thing that a person feels able to control,” Medlock theorized. “Especially for individuals who feel they have already lost control of many other areas of their lives, losing control of the mind is scary.”

Religion and faith have long been the cornerstone of the black community. Medlock, who has a master’s degree in divinity, understands. “We try to pray away mental illness,” she explained. Faith may be able to move mountains, but, when it comes to mental health, it might require a little help from a psychiatrist. Medical and spiritual interventions work together for an individual’s healing.

The impact of stigma is unfortunate. Mental illness can be treated with good results. Medications, such as anti-depressants and mood stabilizers are effective. Meds are part of the treatment. Psychotherapy, or talk therapy is the other. “Talk therapy helps you to get to the root of the problem,” Medlock said. “It causes changes in the brain as do meds.” She stressed the impact of lifestyle. A healthy diet, exercise and some supplements, such as omega 3, all play into a healthy mind, she advised.

Consequences

Ignoring the problem will not make it go away. There can be dire consequences in addition to unnecessary pain and suffering. A government report found that more than one-fourth of all sheltered persons who were homeless had a severe mental illness and more than one-third had chronic substance abuse.

In a presentation to the Massachusetts Association for Mental Health, Steven W. Tompkins, the sheriff of Suffolk County, said, “Approximately 42 percent of Suffolk County inmates present with some form of mental illness that ranges from mild personality disorder to major mental illness. Of that number, approximately 26 percent suffer from a major mental illness.” He went on to explain that many inmates have co-occurring mental health and substance abuse disorders.

Medlock is encouraging. “Some people can recover fully from a mental illness,” she explained. “If the illness no longer impedes one’s ability to have the life they desire, that is considered a full recovery.”