Ending the stigma of "Mental Illness"

Posted: Jul 13, 2006 9:35 AM

You’d think nothing could compare to the heartbreak endured by families whose loved ones suffer from diseases such as cancer or muscular dystrophy.

But as a recent House committee hearing on mental health made clear, the darkest and most devastating of illnesses often deal with the brain. Why? Because of the stigma, ignorance and pathetic health-care/legal policies that surround what we still call “mental illness.” Unfortunately, this phrase makes it sound as if it’s all psychological. The fact is that brain diseases are just as physical as heart diseases, diabetes or any other illness of any other organ.

Unfortunately, I know much more about the issue than I’d like. My late mother suffered from bipolar illness, transforming the best mom in the universe into someone I didn’t recognize. Brain disorders bearing the names of bipolar, depression, schizophrenia and others aren’t about emotions or having “down days” -- they are conditions that affect judgment, mood, actions, relationships, finances, employment, integrity and every other aspect of one’s makeup and human existence.

It’s about time that the powerful, affluent, advanced, wonderful nation that is America address and redress the tragic human and societal consequences of “mental health” policies that are more akin to something you’d expect out of Transylvania in the dark ages rather than from the most blessed nation on earth in the 21st century.

Rep. Sue Myrick, R-N.C., (who sponsored the House hearing) has bravely taken her own familial experience with brain disease and is attempting to turn the tide. Her granddaughter plunged into a living hell when she developed severe bipolar disorder more than a decade ago, taking her family with her (as is often the case). This loving, courageous, unashamed grandmother struggles daily through a broken system that continues to fail the most vulnerable among us. And Rep. Myrick wants to take what she has learned about the failures of our system and help others.

According to Dr. Kay Jamison, a renowned researcher and psychiatrist at Johns Hopkins who also suffers from bipolar disorder, the cost of untreated brain diseases for America’s young is particularly staggering. Dr. Jamison testified at the hearing that at least 70 percent of the teenagers who commit suicide suffer from a potentially treatable major mood disorder. Yet “the effort to develop new treatments for severe mental illness and to prevent suicide seems remarkably unhurried,” she said:

“Every 17 minutes in America, someone commits suicide. Where is the public concern and outrage? … I cannot rid my mind of the desolation, confusion and guilt I have seen in the parents, children, friends and colleagues of those who kill themselves. Nor can I shut out the images of the autopsy photographs of 12-year-old children, or the prom photographs of adolescents who within a year’s time will put a pistol in their mouths or jump from the top floor of a university dormitory building.”

One parent well acquainted with the pain of brain disease also testified: Pete Earley, a former Washington Post reporter who wrote a harrowing book about the state of mental health in this country. As he noted:

“In 1955, some 560,000 Americans were patients in state mental hospitals. Between 1955 and 2000, our nation’s population increased from 166 million to 276 million. If you took the patient-per-capita ratio that existed in 1955 and extrapolated it out based on the new population, you’d expect to find 930,000 patients in mental hospitals today. But there are fewer than 55,000. Where are the others? More than 300,000 are in jails and prisons. Another half-million are on court-ordered probation. The largest public facilities for the mentally ill are not hospitals. They are jails and prisons. They have become our new asylums.”

What can we do to fix this? Dr. Timothy Kelly, a licensed clinical psychologist, several years ago outlined principles for reform in a paper for The Heritage Foundation. It’s time for Congress and society to discuss these principles and start reforming antiquated, cruel policies.

For one thing, we need to focus on results. “Most mental-health management information systems in the public and private sectors simply list demographics and services provided,” Dr. Kelly says. “Rather than documenting process, a valuable evaluation should measure progress -- the actual outcomes of care provided.”

Dr. Kelly also recommends that policymakers:

  • Provide equivalent insurance coverage for severe mental illness. In programs that specify health benefits, that means giving equal coverage for brain diseases as for other diseases. “A person suffering from a serious mental illness may be as debilitated as someone with a serious physical illness, and both should have adequate coverage and access to care,” he says.

  • Establish “outpatient commitment” for mental illness. Currently, the right of an individual with SMI (severe mental illness) to refuse treatment is overridden only if he is deemed at risk of hurting himself or others. “However, once a person has been successfully treated and is discharged from a psychiatric hospital,” Dr. Kelly writes, “the court has no say regarding whether or not he or she continues to receive treatment. In most cases of relapse after discharge, the cessation of treatment, especially of medications, is the primary cause.”

    With outpatient commitment, SMI patients could be discharged early if they agree to remain in treatment in their home community. If they don’t abide by this agreement, they could be re-hospitalized or required to attend a day treatment program. A new commitment hearing wouldn’t be necessary.

  • Require parental approval for child and adolescent mental health treatment. We must safeguard parental rights even as we ensure that children and adolescents who suffer from SMI receive adequate care.

  • Engage those who use mental-health services in the process of reform. “Nobody knows the need for effective treatment more that those who have suffered from ineffective care,” Dr. Kelly says. That’s exactly why we need substantial input from them.

We owe it to our future to get this right. Pete Earley explains why:

“Mental illness is a cruel disease. No one knows who it might strike or why. There is no known cure. It lasts forever. My son Mike has it. And because he is sick, he will always be dancing on the edge of a cliff. I cannot keep him from falling. I cannot protect him from its viciousness. All I can do is stand next to him on that ravine, always ready to extend my hand. All I can do is promise that I will never abandon him.”

America has abandoned those who suffer with brain disorders for far too long. We can, and must, do better.