BULLETIN: Groundbreaking Surgeon General’s Report on Mental Health

The following document highlights the Surgeon General’s scientifically based report and is intended for your use in advocacy efforts, for letters to the editor, and to communicate with other interested parties concerned with this very important document for mental health practitioners and consumers. The Surgeon General’s Report affirms who we are and what we do as social workers.

A copy of the Executive Summary of the report, a resource directory, fact sheets and a catalog of related materials is available from federal agencies call toll-free1-877-9-MHEALTH or write to Mental Health, Pueblo, Colorado. A full copy of Mental Health: A Report of the Surgeon General is available on the World Wide Web at http://www.surgeongeneral.gov or by purchasing it from the Government Printing Office (202) 512-1800. For further information about the subject contact the HHS website at www.dhhs.gov/news/press/

Staff Contacts: Pat Gorman, Congressional Lobbyist, Division of Professional Development and Advocacy, 1-800-638-8799 Extension 336 , email: pgorman@naswdc.org or Nancy Bateman, Senior Staff Associate for Substance Abuse/Mental Health, Division of Professional Development and Advocacy, 1-800-638-8799 Extention 374, email: nbateman@naswdc.org. Denise Rathman, MSW student in field placement at NASW also contributed to the production of this document.

Surgeon General’s Report on Mental Health

In early December 1999, U.S. Surgeon General David Satcher released the first ever Surgeon General’s report on Mental Health. This landmark science-based report calls attention to the fact that mental illness is an "urgent health concern" that this country must address. The report states that mental illness is the second leading cause of disability and premature mortality. One in five Americans experience a mental disorder over the course of a year. While15% of the adult population uses some form of mental health service each year, nearly half of all Americans with severe mental illness do not seek treatment.

The findings of the report provide an opportunity to dispel many of the myths and the stigma that surround mental illness by presenting scientific, fact-based information and research. The Surgeon General confirms that mental disorders are real and that mental health is fundamental to health. The report documents that mental health treatment is effective and includes a range of treatment choices for most mental disorders including psychotherapy and psychopharmacology. It concludes that diagnosis for mental disorders are as reliable as those for general medical disorders. The single explicit recommendation of the report is: "seek help if you have a mental health problem or think you have symptoms of a mental disorder." Early treatment of mental health problems results in less institutionalization and a healthier and more productive society. People with mental illnesses, when treated, can make tremendous positive economic and social contributions to society. The consequences of untreated mental illness produce negative results for the individuals, their families, communities, and society.

The report proposes that one of the single greatest barriers to addressing the issues of mental health is stigma. According to the report, knowledge and increasingly effective treatments gained through a research base are the most effective weapons against this barrier. Additional barriers include our complex and fragmented mental health delivery system (especially for those with serious mental illness), financial concerns, cultural issues and diagnostic factors.

A variety of economic forces and concerns also result in financial barriers to mental health services and have led to differential allocation of resources and financing of mental health coverage. This has led to federal legislative efforts to achieve parity in mental health insurance coverage. Studies show that parity laws have resulted in minimal cost increases. Research indicates that in a managed care program, parity results in less than a one percent increase in overall health care costs. While the report does not directly address parity for substance abuse treatment, it does recognize that fifteen percent of adults with mental disorders also experience a co-occurring substance abuse disorder and cites evidence that individuals benefit most from treating both disorders simultaneously.

The report calls attention to mental health concerns that relate to lifestages as well as the needs of specific populations such as children, older adults, caregivers, veterans, and other vulnerable groups. For example, twenty-one percent of children between 9-17 receive mental health services each year. Their findings support that preventive interventions with children are effective in reducing the impact of risk factors. Additionally, programs for children are best addressed using an organized collaborative systems approach. Local mental health and law enforcement agencies are working to promote healthy childhood development and prevent violent behaviors.

With increased life expectancy, we will expect to see an increase in people with mental disorders over 65. According to the report, a major health problem in the future will be mental health disabilities, such as depression and dementia, in people over 65.

The report highlights that assurance of confidentiality is critical for individuals seeking treatment. It recognizes the sensitive nature of mental heath care and records. Consistent with this finding, NASW advocates for more stringent privacy and confidentiality of mental health information.

In discussing the current mental health system, the report defines services to include both the public and private sector, general health services, specialty mental health providers, social services, housing, criminal justice systems, and educational agencies. It identifies the need for greater integration and coordination for these complex services to facilitate increased access particularly by those with more severe needs and mental disorders. The report advocates a public health perspective, which entails not only diagnosis and treatment, but also health promotion, disease prevention, and ancillary services. To be effective, treatment services must be "culturally competent" as well as gender and age relevant. The report also highlighted that substantial gaps exist in the availability of state of the art mental health services, accessibility of services by those in need and the integration of effective treatment into actual practice.

In summary, the following are the Surgeon General’s recommendations to overcome barriers to access:

• Continue to build the science base
• Overcome stigma through research
• Improve public awareness of effective treatment
• Ensure the supply of mental health services and providers
• Ensure delivery of state-of-the-art treatments
• Tailor treatment to age, gender, race and culture
• Facilitate entry into treatment
• Reduce financial barriers to treatment