Saturday, January 17, 2009

The Impact of Mental Health Conditions on Society

Evolutionary psychiatry and breakthroughs in neuroscience are rapidly blurring the lines between adaptive and maladaptive changes. (See the provocative Survival of the Sickest by Dr. Sharon Moalem; also Quantum Change by Miller and C’ de Baca and Spiritual Evolution by Dr. George Vaillant) If your life has been touched by mental health conditions through work, family or friends, I would appreciate your comments and feedback to help forward my commitment to altering the conversation for mental health. Here it is a new year, a new administration, a new opportunity to create a future for ourselves and our children that we would be proud to leave as legacy. Yes, we can!

An open letter to President Obama

Please update your statistics and revisit your policy on Mental Health. As a person who successfully lives with bipolar disorder, I have a commitment to altering the conversation for mental health. Mental Health parity is only a belated beginning to creating procovery structures for people living with mental health conditions.

The NIMH states that 26.2 % of the US population has a mental health condition which translates into 1 in 4, not 1 in 5 Americans, as stated in your website. Quoting from NIMH "Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people. Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — that suffer from a serious mental illness. In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to co-morbidity.

"The burden of mental illness on health and productivity in the United States and throughout the world has long been underestimated. Data developed by the massive Global Burden of Disease study conducted by the World Health Organization, the World Bank, and Harvard University, reveal that mental illness, (including suicide) accounts for over 15 percent of the burden of disease in established market economies, such as the United States. This is more than the disease burden caused by all cancers." (my emphasis) The WHO (World Health Organization) shows that Depression is one of the top ten diseases in every nation and increasing worldwide.

Presently, the prevailing view of psychiatric disorders is mostly occupied with despair, danger and drain, particularly in the wake of the Virginia Tech campus shooting in the U.S. and like incidents. Little media attention is paid to acknowledging those who contribute to the social good in spite of, or because of, living with a mental health condition. A case in point, TIME magazine's 100-most-influential-people has listed Dr. Craig Venter, the genome maverick, for two years running. Though he has quite publicly self-described himself as having Bipolar Disorder (see The Hypomanic Edge, by John D. Gartner, Simon & Schuster, 2005), there was no word of this in either article.

Philip Burguières, a former Fortune 500 CEO who has had major depression, now works with executives who have mental health conditions. From a Newsweek article (2/26/07, p.44): "Today he is fully recovered and spends 10 hours a week counseling other CEOs. 'The way you get to those positions in today's world, you have to be a little more obsessive, more driven. Those qualities are things that lead to depression.' He's met hundreds of CEO's and boldly estimates as many as half of the people running Fortune 500 companies have the disease." (my emphasis)

Largely missing in the public discourse is the recognition that many people successfully manage their mental health issues. Who might be inspired to seek treatment or create structures for wellness if there were more discussion? How would health care protocols and delivery be impacted? How would people with mental health conditions be viewed and how would they view themselves? What would be available to us as human beings? Even without modern treatments for depression, Abraham Lincoln served as President of the United States and Winston Churchill as Prime Minister of England.

Physical health cannot be maintained or obtained without first addressing issues of mental health. The most cost effective and therapeutically effective protocols have been proven to be evidence-based practices. National implementation of these community-based, integrated approaches is being supported by NASMHPD (National Association of State Mental Health Program Directors) and SAMHSA (Substance Abuse and Mental Health Services Administration), but it will take continued political will to have these procedures supersede the dependence on medication alone. As a leading advocate and researcher, Dartmouth's Dr. Robert E. Blake noted in a recent Harvard Psychiatry Conference lecture, science is driven by biases that dollars should go to medication rather than studying self-help and support though we know they work (lower incidence of relapse, and less time in hospital if relapse occurs). Add lifestyle choices like exercise, nutrition, meditation and other awareness or spiritual practices and routine management of these conditions could become the norm.

As President of DBSA-Boston, one of the oldest and most successful chapters of the Depression Bipolar Support Alliance--the leading peer-led support group organization for mood disorders, I see the efficacy of our programs every week. Procovery is a process and requires many partners. I hope that your administration will meaningfully address mental health in the next four years.


Our world is created in language, and altering the conversation begins with re-languaging how we speak about mental health conditions, the people who have them, ourselves. I choose “procovery” over recovery for several reasons. Most importantly, recovery infers a return to something, a looking back to what may or may not have been. Procovery begins in the here and now. I wish I could take credit for the concept but it belongs to the work of Kathleen Crowley. ”The fundamental focus of Procovery is one of moving forward when you can no longer move back, of letting go of what was and rebuilding new dreams. …Procovery offers individuals diagnosed with serious or chronic disorders an approach to attaining [and maintaining] a productive and fulfilling life….” (From the website

1 comment:

  1. I recently came across a statement by the World Health Organization estimating that by 2020 the second leading cause of death, after heart failure, will be depression. Horrendous! We cannot allow this to happen in our world, on our watch!

    As a human being moving forward after the death of her beautiful 22-year old daughter by suicide in 2003, I have a commitment to the possibility of wellness for all.

    Some recent discoveries I have made include:

    The Centers for Disease Control document entitled, Connectedness as a Strategic Direction for the Prevention of Suicidal Behavior. It talks about promoting and strengthening connectedness at the personal, family and community level. Challenge Day provides this to our middle and high school teens, a group where suicide is the third leading cause of death.

    Florida Self-Directed Care (SDC) is an innovative service delivery paradigm placing individuals with mental illnesses squarely at the center of decision-making that affects them.

    Mental Health First Aid is a 12-hour interactive certification course designed to reduce the stigma surrounding mental health conditions by increasing an individual's skill in helping a person cope with a mental health crisis. It provides tools and resources to help overcome fear of a mental health crisis.

    We're all in this together, and YES, WE CAN!

    Marie Dudek
    Chair - Central Florida Chapter
    American Foundation for Suicide Prevention - make it a daily practice