NNBBHS.pdf - Mental He,alth A Report of the Surgeon General DEPARTMENT OF HEALTH AND HUMAN U.S Public Health Service SERVICES The Center for Mental

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Unformatted text preview: Mental He,alth A Report of the Surgeon General DEPARTMENT OF HEALTH AND HUMAN U.S. Public Health Service SERVICES The Center for Mental Health Servides Substance Abuse and Mental Health Services Administration National Institute of Mental Health National Institutes of Health Suggested Citation U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. For sale by the Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 1X250-7954 Message from Donna E. Shalala Secretary of Health and Human Services The United States leads the world in understanding the importance of overall health and wellbeing to the strength of a Nation and its people. What we are coming to realize is that mental health is absolutely essential to achieving prosperity. According to the landmark “Global Burden of Disease”study, commissioned by the World Health Organization and the World Bank, 4 of the 10 leading causesof disability for persons age 5 and older are mental disorders. Among developed nations, including the United States,major depression is the leading causeof disability. Also near the top of these rankings are manic-depressiveillness, schizophrenia, and obsessive-compulsive disorder. Mental disorders also are tragic contributors to mortality, with suicide perennially representing one of the leading preventable causesof death in the United States atid.worldwide. The U.S. Congress declared the 1990sthe Decade of the Brain. In this decade we have learned much through research-in basicneuroscience,behavioral science,and genetics-about the complex workings of the brain. Research can help us gain a further understanding of the fundamental mechanismsunderlying thought, emotion, and behavior- and an understandingof what goes wrong in the brain in mental illness. It can also lead to better treatments and improved services for our diverse population. Now, with the publication of this first Surgeon General’s Report on Mental Health, we are poised to take what we know and to advancethe state of mental health in the Nation. We can with great confidence encourage individuals to seek treatment when they find themselvesexperiencing the signs and symptoms of mental distress. Researchhas given us effective treatments and service delivery strategies for many mental disorders. An array of safe and potent medications and psychosocial interventions, typically used in combination, allow us to effectively treat most mental disorders. This seminal report provides us with an opportunity to dispel the myths and stigma surrounding mental illness. For too long the fear of mental illness has been profoundly destructive to people’s lives. In fact mental illnesses are just as real as other illnesses, and they are like other illnesses in most ways. Yet fear and stigma persist, resulting in lost opportunities for individuals to seek treatment and improve or recover. In this Administration, a persistent, courageous advocate of affordable, quality mental health services for all Americans is Mrs. Tipper Gore, wife of the Vice President. We salute her for her historic leadership and for her enthusiastic support of the initiative by the Surgeon General, Dr. David Satcher, to issue this groundbreaking Report on Mental Health. The 1999 White House Conference on Mental Health called for a national antistigma campaign. The Surgeon General issued a Call to Action on Suicide Prevention in 1999 as well. This Surgeon General’s Report on Mental Health takesthe next step in advancing the important notion that mental health is fundamental health. Foreword Since the turn of this century, thanks in large measure to research-based public health innovations, the lifespan of the averageAmerican has nearly doubled. Today, our Nation’s physical health-as a whole-has never been better. Moreover, illnesses of the body, once shrouded in fear-such as cancer, epilepsy, and HIV/AIDS to namejust a few -increasingly are seenas treatable, survivable, even curable ailments. Yet, despiteunprecedentedknowledge gained in just the past three decadesabout the brain and human behavior, mental health is often an afterthought and illnesses of the mind remain shrouded in fear and misunderstanding. This Report of the Surgeon General on Mental Health is the product, of an invigorating collaboration between two Federal agencies. The Substance Abuse and Men&Health Services Administration (SAMHSA), which provides national leadership and funding to the statesand many professional and citizen organizations that are striving to improve the availability, accessibility, and quality of mental health services,was assignedlead responsibility for coordinating the development of the report. The National Institutes of Health (NM), which supports and conducts research on mental illness and mental health through its National Institute of Mental Health (NIMH), was pleased to be a partner in this effort. The agencieswe respectively head were able to rely on the enthusiastic participation of hundreds of people who played a role in researching, writing, reviewing, and disseminating this report. We wish to express our appreciation and that of a mental health constituency, millions of Americans strong, to Surgeon General David Satcher, M.D., Ph.D., for inviting us to participate in this landmark report. The year 1999 witnessed the first White House Conference on Mental Health and the first Secretarial Initiative on Mental Health prepared under the aegis of the Department of Health and Human Services.These activities set an optimistic tone for progress that will be realized in the years ahead. Looking ahead, we take special pride in the remarkable record of accomplishment, in the spheresof both scienceand services,to which our agencieshave contributed over past decades.With the impetus that the Surgeon General’s report provides, we intend to expand that record of accomplishment.This report recognizesthe inextricably intertwined relationship between our mental health and our physical health and well-being. The report emphasizesthat mental health and mental illnesses are important concerns at all ages. Accordingly, we will continue to attend to needs that occur across the lifespan, from the youngest child to the oldest among us. The report lays down a challenge to the Nation- to our communities, our health and social service agencies,our policymakers, employers,and citizens-to take action. SAMHSA and NIH look forward to continuing our collaboration to generateneededknowledge about the brain and behavior and to translate that knowledge to the service systems,providers, and citizens. Nelba Chavez, Ph.D. Administrator SubstanceAbuse and Mental Health Services Administration Steven E. Hyman, M.D. Director National Institute of Mental Health for The National Institutes of Health Bernard S. Arons, M.D. Director Center for Mental Health Services Preface from the Surgeon C&era/ U.S. Public Health Service The past century has witnessed extraordinary progress in our improvement of the public health through medical scienceand ambitious, often innovative, approachesto health care services.Previous SurgeonsGeneral reports have saluted our gains while continuing to set ever higher benchmarksfor the public health. Through much of this era of great challenge and greater achievement, however, concerns regarding mental illness and mental health too often were relegated to the rear of our national consciousness.Tragic and devastating disorders such as schizophrenia, depression and bipolar disorder, Alzheimer’s disease,the mental and behavioral disorders suffered by children, and a range of other mental disorders affect nearly one in five Americans in any year, yet continue too frequently to be spoken of in whispers and shame. Fortunately, leaders in the mental health field-fiercely dedicated advocates, scientists, government officials, and consumers-have been insistent that mental health flow in the mainstreamof health. I agreeand issue this report in that spirit. This report makes evident that the neuroscience of mental health-a term that encompasses studiesextending from molecular events to psychological, behavioral, and societal phenomena-has emerged as one of the most exciting arenasof scientific activity and human inquiry. We recognize that the brain is the integrator of thought, emotion, behavior, and health. Indeed, one of the foremost contributions of contemporary mental health research is the extent to which it has mended the destructive split between “mental’ and “physical” health. We know more today about how to treat mental illness effectively and appropriately than we know with certainty about how to prevent mental illness and promote mental health. Common sense and respect for our fellow humans tells us that a focus on the positive aspects of mental health demandsour immediate attention. Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and accessto its services.Thesedisparities are viewed readily through the lensesof racial and cultural diversity, age, and gender. A key disparity often hinges on a person’s financial status; formidable financial barriers block off needed mental health care from too many people regardlessof whether one has health insurance with inadequatemental health benefits, or is one of the 44 million Americans who lack any insurance. We have allowed stigma and a now unwarranted senseof hopelessnessabout the opportunities for recovery from mental illness to erect these barriers. It is time to take them down. Promoting mental health for all Americans will require scientific know-how but, even more importantly, a societal resolve that we will make the neededinvestment. The investment does not call for massivebudgets; rather, it calls for the willingness of each of us to educate ourselves and others about mental health and mental illness, and thus to confront the attitudes, fear, and misunderstanding that remain as barriers before us. It is my intent that this report will usher in a healthy era of mind and body for the Nation. David Satcher, M.D., Ph.D. Surgeon General Acknowledgments Acknowledgments This report was prepared by the Department of Health and Human Services under the direction of the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, in partnership with the National Institute of Mental Health, National Institutes of Health. Nelba Chavez, Ph.D., Administrator, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Nicole Lurie, M.D., M.S.P.H., Principal Deputy Assistant Secretary for Health, Office of Public Health and Science, Office of the Secretary, Washington, D.C. RADM Arthur Lawrence, Ph.D., Deputy Assistant Secretary for Health, Office of Public Health and Science, Office of the Secretary, Washington, D.C. VirginiaTrotterBetts,M.S.N., J.D.,R.N.,F.A.A.N., Senior Advisor on Nursing and Policy, Office of Public Health and Science, .Office of the Secretary, Washington, D.C. Harold E. Varmus, M.D., Director, National Institutes of Health, Bethesda, Maryland. Editors Bernard Arons, M.D., Director, Center for Mental Health Services, SubstanceAbuse and Mental Health Services Administration, Rockville, Maryland. Howard H. Goldman, M.D., Ph.D., Senior Scientific Editor, Professor of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland. Steven Hyman, M.D., Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. CAPT Patricia Rye, J.D., M.S.W., Managing Editor, Office of the Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. RADM Thomas Bornemann, Ed.D., Deputy Director, Center for Mental Health Services, SubstanceAbuse and Mental Health Services Administration, Rockville, Maryland. Paul Sirovatka, M.S., Coordinating Editor, Science Writer, Office of Science Policy and Program Planning, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. Richard Nakamura, Ph.D., Deputy Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. Section RADM Kenneth Moritsugu, M.D., M.P.H., Deputy Surgeon General, Office of the Surgeon General, Office of the Secretary, Rockville, Maryland. Editors Jeffrey A. Buck, Ph.D., Director, Office of Managed Care, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. RADM Susan Blumenthal, M.D., M.P.A., Assistant Surgeon General and Senior Science Advisor, Office of the Surgeon General, Office of the Secretary, Rockville, Maryland. CAPT Peter Jensen, M.D., Associate Director for Child and Adolescent Research, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. . vii Mental Health: A Report of the Surgeon General Judith Katz-Leavy, M.Ed., Senior Policy Analyst, Office of Policy, Planning and Administration, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Planning Board Mary Lou Andersen, Deputy Director, Bureau of Primary Health Care, Health Resourcesand Services Administration, Bethesda,Maryland. Andrea Baruchin, Ph.D., Chief, SciencePolicy Branch, Office of SciencePolicy and Communication,National Institute on Drug Abuse, National Institutes of Health, Bethesda,Maryland. Barry Lebowitz, Ph.D., Chief, Adult and Geriatric Treatment and Preventive Intervention Research Branch.Division of Servicesand Intervention Research, National Institute of Mental Health, National Institutes of Health, Bethesda,Maryland. Michael Benjamin, M.P.H., Executive Director, National Council on Family Relations, Minneapolis, Minnesota. Ronald W. Manderscheid, Ph.D., Chief, Survey and Analysis Branch, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Robert Bernstein, Ph.D., Executive Director, Bazelon Center, Washington, D.C. RADM Darrel Regier, M.D., M.P.H., Associate Director, Epidemiology and Health Policy Research, National Institute of Mental Health, National Institutes of Health, Bethesda,Maryland. Gene Cohen, M.D., Ph.D., Director, George Washington University Center on Aging, Health and Humanities; Director, Washington D.C. Center on Aging, Washington, D.C. Matthew V. Rudorfer, M.D., Associate Director for Treatment Research, Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. Judith Cook, Ph.D., Director, National Researchand Training Center on Psychiatric Disability; Professor, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois. Margaret Coopey, R.N., Senior Health Policy Analyst, Director, Center for Practice and Technology Assessment, Agency for Health Care Policy and Research,Rockville, Maryland. Senior Science Writer Miriam Davis, Ph.D., Medical Writer and Consultant, Silver Spring, Maryland. Gail Daniels, Board President, The Federation of Families for Children’s Mental Health, Washington, D.C. Science Writers Paolo Del Vecchio, M.S.W., Senior Policy Analyst, Office of Policy, Planning, and Administration, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Birgit An der Lan, Ph.D., Science Writer, Bethesda, Maryland. Anne H. Rosenfeld, Special Assistant to the Director, Division of Mental Disorders,Behavioral Researchand AIDS, National Institute of Mental Health, National Institutes of Health, Bethesda,Maryland. Michael Eckardt, Ph.D., Senior ScienceAdvisor, Office of Scientific Affairs, National Institute on Alcohol Abuse and Alcoholism National Institutes of Health, Rockville, Maryland. ... Vlll Acknowledgments Mary Jane England, M.D., President, Washington BusinessGroup on Health, Washington, D.C. Elliott Heiman, M.D., Chief of Staff of Psychiatry, St. Marys Hospital, Tucson, Arizona. Michael English, J.D., Director, Divisionof Knowledge Development and SystemsChange, Center for Mental Health Services, SubstanceAbuse and Mental Health Sewices Administration, Rockville, Maryland. Kevin Hennessy,M.P.P., Ph.D., Health Policy Analyst, Office of the Assistant Secretary for Planning and Evaluation, Office of the Secretary,Washington, D.C. Pablo Hemandez,M.D., Administrator, Wyoming State Commission for Mental Health, Division of Behavioral Health, Evanston, Wyoming. Michael M. Faenza, M.S.S.W., President and Chief ExecutiveOfficer, National Mental Health Association, Alexandria, Virginia. Thomas Horvath, M.D., Chief of Staff, Houston Veterans Affairs Medical Cent&, .Houston,Texas. Michael Fishman,M.D., AssistantDirector, Division of Child. Adolescent and Family Health, Bureau of Maternal and Child Health, Health Resources and ServicesAdministration, Rockville, Maryland. J. Rock Johnson,J.D., Consultant, Lincoln, Nebraska. Miriam Kelty, Ph.D., Associate Director for Extramural Affairs, National Institute on Aging, National Institutes of Health, Bethesda,Maryland. Laurie Flynn, Executive Director, National Alliance for the Mentally Ill, Arlington, Virginia. Lloyd Kolbe, Ph.D., Director, Division of Adolescent and School Health, National Centerfor Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Larry Fricks, Director, Office of ConsumerRelations, Georgia Division of Mental Health, Atlanta, Georgia. Robert Friedman, Ph.D., Director, Research and Training Center for Children’s Mental Health, Florida Mental Health Institute, University of South Florida, Tampa. Florida. Jeffrey Lieberman, M.D., Vice Chairman of Research, University of North Carolina, Departmentof Psychiatry, Chapel Hill, North Carolina. Laurie Garduque, Ph.D., Senior Program Officer, Program and Community Development, MacArthur Foundation,Chicago, Illinois. Spero Manson, Ph.D., Director, Division of American Indian and Alaska Native Programs, University of Colorado Health Science Center, Department of Psychiatry, Denver, Colorado. John J. Gates, Ph.D., Director of Programs, Collaborative Center for Child Well-being, Decatur, Georgia. RADM C. Beth Mazzella, R.N., Ph.D., Chief Nurse Officer, Office of the Administrator, Health Resources and ServicesAdministration, Rockville, Maryland. RosaM. Gil, D.S.W., Special Advisor to the Mayor for Health Policy, New York City Mayor’s Office of Health Services, New York, New York. Bruce McEwen, Ph.D., Professor and Head of the Lab for Neuroendocrinology, Rockefeller University, New York, New York. Barbara Gill, M.B.A., Executive Director, Dana Alliance for Brain Initiatives, New York, New York. Mary Harper, R.N., Ph.D., Gerontologist, Tuscaloosa, Alabama. ix Mental Health: A Report of the Surgeon General Herbert Pardes, M.D., Vice President for Health Sciences and Dean of the Faculty of Medicine, Columbia University Health Sciences Center, New York, New York. Participants in Developing the Report Norman Abeles, Ph.D., Department of Psychology, Michigan State University, East Lansing, Michigan. Ruth Ralph, Ph.D., Research Associate, Edmund S. Muskie School of Public Service, University of Southern Maine, Portland, Maine. Catherine Acuff, Ph.D., Senior Health Policy Analyst, Office of the Director, Center for Mental Health Services,SubstanceAbuse and Mental Health Services Administration, Rockville, Maryland. The Honorable Robert Ray, Former Governor, Stateof Iowa, Des Moines, Iowa. Laurie Ahem, Director, National EmpowermentCenter, Inc., Lawrence, Massachusetts. Corinne Rieder, Ed.D., Executive Director, John A. Hartford Foundation, New Y...
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