Very common but often goes untreated
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.
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 “A person may no longer interact at school or church and becomes withdrawn.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.”
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.
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.
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.”