Francis 1 Shannon Francis Professor Mateer LA101H 9 April 2012 Proposed Reform of Mental Healthcare Policies in the United

States Mental illness is not the most well-understood type of disability. While the Surgeon General has acknowledged that mental disorders are real health conditions that have an immense impact on individuals and families throughout the Nation, this knowledge has not transcended into the general populace of our country. Bodily diseases such as cancer and even the common cold have physical symptoms that are, more or less, easily understood by the general population. Diseases of the mind, however, are harder to diagnose and even recognize. They are a kind of invisible illness. Even though in any given year a quarter of the adult population is diagnosable for one or more mental disorders (NIMH), mental illnesses are still not very understood by the general public. This has resulted in inefficient and ineffectual policies regarding both the rights of the mentally ill as well as the regulation and quality of the establishments and resources available for their recovery. This results in unnecessary stress and suffering for the large percentage of the population that suffers from mental illnesses, and policy reform is desperately needed in order to fix this broken system. As someone who suffers from bipolar

Francis 2 disorder, and as someone who has seen the condition that the mental helathcare system is in first hand, I am well aware of this desperate need for change. One of the biggest problems with the current mental healthcare system is the high rate of misdiagnosis. It is often extremely difficult for a patient to get a clear and correct diagnosis right away, resulting in subjection to extensive therapy and drugs that may even worsen their symptoms. While I will admit that mental illness is more difficult to diagnose than physical illness, a large part of the misdiagnosis problem is the patients' reliance on under qualified and even biased physicians. When my problems got out of hand and I went into a strong depressive swing, I went to see my general practitioner. He had hardly any training in dealing with mental illness and certainly wasn't equipped to properly diagnose or treat me, but for me as well as many other people, my family doctor was the only person I had to go to. After going in and talking for a bit, he tentatively diagnosed me with depression and prescribed me a well-known anti-depressant called Zoloft. While I probably should not have taken his diagnosis as fact and refused his proposed treatment, this was a doctor I had known for eighteen years of my life; I trusted him and had faith that he knew what was wrong and how to fix it. As it turns out, he was wrong. I, along with about half of other bipolar disorder sufferers (Bruce), had been misdiagnosed with depression. Granted, it is a common misdiagnosis -- one of the symptoms of bipolar disorder is a mood swing into feeling incredibly sad and depressed, and because patients are often encouraged to seek help during the depressive phase, their other symptoms (such as a mood swing into an extremely hyper and creative mood) are ignored by whoever is diagnosing them. However, there are a handful of differences between bipolar (even in the depressive phase) and depression which can help provide a correct diagnosis. It is extremely important for not just psychiatrists and those specializing in mental illness to be aware of such differences between mental disorders; all physicians need to be made more aware of these

Francis 3 differences as well, and should only have the power to refer a patient to someone with better knowledge of mental illness. Policy needs to be reformed so that general practitioners and doctors specialized in physical illness are unable to prescribe medication intended for the treatment of mental disorders, because a misdiagnosis and mistreatment can be extremely detrimental to the patient's mental health. Take depression and bipolar, for example: The problem with the failed diagnosis is that while antidepressants can be effective for treating depression and anxiety, it is not an appropriate treatment for those suffering from bipolar disorder. In fact, antidepressants can actually amplify and worsen the symptoms of bipolar disorder (Bruce). The fact that my misdiagnosis and mistreatment resulted in the worsening of my condition should serve to prove that only professionals trained with knowledge of mental illness (such as psychiatrists) should be permitted to diagnose and prescribe medication to patients. Even once patients have been properly diagnosed, it can still be incredibly difficult to obtain adequate treatment. Aside from the fact that people with mental illness may not seek treatment or feel that they need it, simply knowing where to go once they decide to seek help can be a challenge. From my personal experience, it was a struggle finding a therapist that I could afford in my area, and even seeking help from the Universitys services required a lengthy interview and appointment process. In fact, until a mental breakdown placed me in a psychiatric ward, I had been unsuccessful in getting any sort of help for my mental problems. I stand as one example amidst a much larger problem, however. In the United States, lack of available mental health services is a serious problem. Let us look, for example, one of the most prevalent mental disorders in the United States: depression. According to Mental Health America, depression affects more than 21 million American children and adults annually and is the leading cause of disability in the United States for individuals ages 15 to 44. One would think that such a widespread disability would warrant proper treatment from those who suffer from it. However, depression simply serves to prove how difficult it is for sufferers of mental

Francis 4 illness to get adequate treatment: Despite significant gains in the availability of effective depression treatment over the past decade, the level of unmet need for treatment remains high. On average, people living with depression go for nearly a decade before receiving treatment, and less than one-third of people who seek help receive minimally adequate care (MHA). To put this into perspective, this means that, if every single person with depression sought treatment, over 14 million of them would go without the absolute minimum care that they required. Unfortunately, seeing as not every sufferer of depression seeks help, in reality the number who do not receive treatment is much, much higher. Furthermore, these statistics apply to only one of the most common mental disorders. When other mental disorders such as bipolar and schizophrenia are taken into account, tens of millions of Americans who actually seek treatment are unable to access the absolute minimum adequate care. Policies need to be implemented so that, at the very least, sufferers of mental illness who actually seek help are able to attain it. While there are state- and private-sponsored organizations in place to help the mentally ill, they are obviously not nearly enough to deal with the large number of patients in need of help. More spending needs to be allocated to at least the most very basic of mental health services, especially focused in low-income and rural areas where sufferers may not be able to afford adequate treatment or where treatment options may simply not exist. Once mental health services are available to a sufferer, however, the sheer cost of treatment may prevent someone with mental illness form being able to take advantage of treatment options. Even after I was diagnosed, it only took a few weeks of $20 a week copay for my medication to make me realize that I was not going to be able to afford it on my own. In addition to that, counseling and psychiatric services are too expensive for a college student like me to even be able to fathom affording, even after insurance. I was lucky to even have insurance, too, because the cost of my inpatient treatment was around $500 a

Francis 5 day. It is not a matter of these resources simply being outrageously expensive, but also of the more indirect costs of having a mental illness: Unlike other medical disorders, the costs of mental disorders are more "indirect" than "direct." The costs of care (e.g., medication, clinic visits, or hospitalization) are direct costs. Indirect costs are incurred through reduced labor supply, public income support payments, reduced educational attainment, and costs associated with other consequences such as incarceration or homelessness (Insel). Personally, I was unable to work for the weeks leading up to my inpatient treatment at a psychiatric hospital, and even after I was released, I was too shaken up and too exhausted to return to my job for another few weeks. In that short period alone I lost a few hundred dollars from my part-time that I could have used to eat or even afford my medication. I was lucky in only losing a few hundred dollars, however. Insel goes on to further state that, simply in terms of loss of income, mental illness on average results in a loss of $16,306 per person per year. In addition to that, on average, treatment for mental disorders costs $1,591 per person per year. When all of these costs and all of these people are added up, mental illness costs the nation over $300 billion dollars per year (NIMH). The problem is that, only 6.2% of current U.S. health care spending is devoted to the treatment of mental disorders (Kingsbury). Based on how widespread and costly mental illness is, this percentage

Francis 6 needs to rise. More healthcare spending needs to be allocated to mental helathcare, especially in providing cheap or even free basic treatment to the general population. This will allow sufferers who have already taken a great deal of financial loss in terms of loss of income to hopefully have access to affordable services that will allow them the basic treatment they need to hopefully be able to work normally and earn better income from their jobs. Once someone who is mentally ill is able to afford and receive care, it is extremely important that said care is of adequate quality to provide beneficial treatment. Sadly, there is a very long history of abuse in the mental healthcare system, and patients can end up as human lab rats, beaten, bruised, and given medication with detrimental side-effects instead of actually treated. In my stay in inpatient treatment, I met a girl named Jess. She was pretty outgoing, energetic, and always spoke what as on her mind. About halfway through the week, the psychiatrist put her on some new medication. She went from being the Jess that I knew to a stumbling, lethargic girl who could barely speak because her words slurred so badly. Even though she begged the doctor to give her a different kind of medication (or at least a lower dosage) in order to relieve the negative side-efffects, he refused to change her prescription until she simply refused to keep taking the pills. Compared with the negative side-effects of other drugs pushed onto the mentally ill, however, Jess was lucky. Statistics have shown that psychiatric drugs can cause symptoms they are prescribed to treat, such as violence and mental incompetence. According to the Citizens Commission on Human Rights, a 1985 investigation into a commonly prescribed tranquilizer, reported in the American Journal of Psychiatry , found that 58% of the treated patients experienced serious dyscontrol, i.e., violence and loss of control compared with only 8% who were given a placebo. The problem with this is that this kind of behavior is used to justify involuntary commitment to mental institutions by psychiatrists, ensuring that patients will receive unnecessary treatment based on a condition caused by the very drugs intended to treat them. In addition to mental effects, the drugs can also cause extremely harmful physical

Francis 7 side effects: the latest neuroleptics actually have even more severe side effects: blindness, fatal blood clots, heart arrhythmia, heat stroke, swollen and leaking breasts, impotence and sexual dysfunction, blood disorders, painful skin rashes, seizures, birth defects and extreme inner-anxiety and restless (CCHR). Furthermore, psychiatric drugs can have extremely severe withdrawal symptoms. Anti-depressants, for instance, can cause withdrawal symptoms agitation, severe depression, hallucinations, aggressiveness, hypomania [abnormal excitement] and akathisia [extreme restlessness] (CCHR). This leads to a lifetime dependance on these drugs, even past the initial treatment. Once patients start treatment using these kinds of medications, they may never be able to return to a healthy, non-medicated lifestyle, and be subjected to the harmful side-effects for the rest of their years. There need to be stricter regulations on drugs intended for the treatment of mental disorders. Psychiatrists should be required by law to explain to their patients all of the negative side-effects of treatment, and the patient's right to refuse such treatment needs to be protected. Furthermore, the state should provide incentives for research into safer forms of treatments as well as incentives for the prescription of safer drugs. After all, there is hardly any point in actively seeking out treatment that will simply make the patient's symptoms and situation even worse. It is time for the struggles of the mentally ill to be seen. It is time for our country to take responsibility to start fighting back against illnesses that affect a quarter of its population, and in ensuring that the mentally ill have easy, affordable access to quality treatment and care, we are taking the first step. Policy change certainly is not something that is easy, but when it concerns the health and well being of our country's citizens, it is certainly something that is necessary.

Francis 8 Works Cited "Annual Total Direct and Indirect Costs of Serious Mental Illness (2002)." NIMH Statistics. National Institute of Mental Health, 2002. Web. 16 Apr. 2012. "Any Disorder Among Adults." NIMH Statistics Any Disorder in Adults Among Adults. National Institute of Mental Health. Web. 16 Apr. 2012. Bruce, Shadra. "Bipolar Disorder Is Often Misdiagnosed as Depression." Mentalhealthnews.org. Mental Health News Organization, 21 July 2010. Web. 16 Apr. 2012. Davis, Miriam. "Executive Summary." Mental Health: A Report of the Surgeon General. Department of Health and Human Services. Web. 16 Apr. 2012. Insel, Thomas R. "Assessing the Economic Costs of Serious Mental Illness." Psychiatryonline.org. The American Journal of Psychiatry, 1 June 2008. Web. 16 Apr. 2012. "Mental Health Abuse The Real Crisis." Mental Health Abuse. Citizens Commission on Human Rights, 2004. Web. 16 Apr. 2012. "Ranking America's Mental Health: An Analysis of Depression Across the States." Mental Health America:. Mental Health America, 2012. Web. 16 Apr. 2012.