Mental Health Facts
Mental health care facts from the American Counseling Association’s Office of Public Policy and Legislation, March 2008.
= An estimated 28 to 30 percent of the adult population in the United States will
suffer from a mental or substance use disorder during the course of a year.
= In 2003, 5 percent of children aged 4 to 17 were reported by a parent to have
moderate or severe difficulties with emotions, concentration, behavior, or
interpersonal relationships. Of those, 65 percent of the parents of these
children contacted a mental health professional or general physician and/or
that the child received special education for these difficulties.
= It is estimated that about 75 percent of children with emotional and behavioral
disorders do not receive specialty mental health services.
= Only one-third of seniors who live in the community who need mental health
services actually receive them. Less than 3 percent of older Americans report
seeing mental health professionals, the smallest percentage of any age group.
= The suicide rate among white males, 85 and older, is more than five times the
rate of the general population.
= Mental illness causes more days of work loss and work impairment than many
other chronic conditions such as diabetes, asthma, and arthritis. Approximately
217 million days of work are lost annually related to mental illness and
substance abuse disorders, costing employers $17 billion each year.
= Prisons, juvenile detention facilities, nursing homes, and homeless shelters
have become the largest providers of mental health services, often at a much
higher cost to taxpayers than modest, preventive and support services. Without
adequate treatment, most individuals and families with mental illness become
more dependent on welfare payments and expensive crisis-driven services. Each
year, more than 100,000 youths are placed in some sort of correctional
facility. An estimated 80 percent have some sort of mental disorder.
= The National Institute of Mental Health has shown that the success rates of
treatment for disorders such as depression (70 to 80 percent) and panic
disorder (70 to 90 percent) surpass success rates for other medical conditions.
END
Psychological Symbiosis
In-house behavior health providers give patients real-time access to counselors,
improve care for mental health problems, and save physicians time. It’s the ultimate win-win arrangement.
By Cindy Murphy Mcmahon
Maryanne is a 36-year-old professional, married woman with two children. She is
having stress-related symptoms during a difficult time in her life, and her
internal medicine physician suggests that she could benefit from seeing a
psychologist. She has never seen a mental health professional before and her
reaction is, “I’m not crazy. I don’t need to see anyone like that.”
Ask any physician if he or she believes that medical care alone will cure a
patient. Odds are not too many will be entirely confident of that optimistic,
albeit desirable, outcome.
Primary care physicians, although trained to diagnose and treat many mental
health issues, often find that behavioral health providers—psychologists, social workers and professional counselors—can augment medical care and help improve a patient’s chance for a more complete recovery.
“There are a lot of medical problems that can’t be treated by just starting a person on medication,” says Jim King, MD, the president of the American Academy of Family Physicians
and a private practitioner in Selmer, Tennessee. “A family practice physician is trained to take care of many mental health
problems, such as anxiety, depression, even substance abuse and other problems.
We take care of a lot of that. And we make referrals for some patients to get
services added, like we would for any other specialty or subspecialty in a
particular area.”
Patients sometimes need professional help with coping mechanisms, however,
whether they are grieving the loss of a loved one or just need someone to help
them work through mental health problems. Says King, “They need to spend time talking to someone with that kind of training.”
So, family practice and other primary care physicians refer their patients to
see behavioral health professionals. But just because a patient leaves a
physician’s office with instructions to see a behavioral health provider—or even with an actual appointment in hand, arranged by the physician’s office—doesn’t mean the appointment will take place. Compliance is out of the physician’s hands.
Partnerships a growing trend
That is one reason some physicians are teaming up, or co-locating, with
behavioral health providers (BHPs) in their own medical offices—to ensure that patients will get the support they need to complement their
medical treatment.
Such in-house partnering is not new, but interest in this arrangement appears to
be growing, although official figures are not available on how widespread the
practice is.
A forum on mental health services in primary care sponsored by Georgetown
University in July 2006, which focused on children’s health needs, recommended co-location as one strategy to better serve patients
and their families. The forum concluded that BHPs, particularly early childhood
mental health specialists, should be co-located with primary care providers to
screen, assess, and treat patients, as well as refer them to other services and
coordinate care.
The Veterans Health Administration has been increasing the number of co-located
mental health professionals in its medical clinics for 15 years, according to
Linda Van Egeren, PhD, a clinical psychologist at the Women’s Comprehensive Health Center at the Minneapolis VA Medical Center. Van Egeren
was among the first mental health professionals to co-locate at a VA facility
when she came there in 1993. She and a mental health clinical nurse specialist
work full time at the women’s clinic, and a psychiatrist is onsite about one and a half days per week.
She says that primary care providers end up dealing with patients’ psychological problems whether they are diagnosed or not, adding that, “Mental health care cannot be divorced from primary medical care.
“The point of our model is to ensure that mental health care is perceived as part
of health care. It’s a more holistic approach, not the body/mind separation. It is very beneficial
to patients because there is less stigma for receiving mental health services.”
Ralph Leonard, MD, is a VA staff physician, board-certified in internal medicine
and geriatrics, at the Minneapolis VA Medical Center. He works in a primary care
clinic and admits that, initially, he was skeptical of having BHPs located in
the clinic.
“I’ll admit I was a bit reluctant to have some of our scarce office space used by
others, but we shifted things around and they are such a valuable addition,” Leonard says. The clinic employs psychologists and RN depression case managers.
The depression case manager program started about two and a half years ago,
while the psychologist started in April 2007. An additional project involves a
nurse specialist who screens all patients older than 75 for dementia.
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Case managers also spend time listening to patients, many of whom have a
situation that has precipitated their mood problem, such as a recent loss or
posttraumatic stress disorder (PTSD), and “although they suggest some helpful coping mechanisms, I think a major service
our depression case managers provide is to be a good listener and supporter,” Leonard says.
At the VA, patients who require cognitive behavior therapy can be seen by the
clinic’s psychologists in the course of a regular visit. This initial assessment can
occur within an hour of referral, whether the referral is initiated by the
patient or clinical staff. “This is very helpful for patients with complex social stressors who we want to
help because we do not have the flexibility in our schedules to attend to every
issue in detail,” says Leonard. “Our psychologists are also very good at troubleshooting challenging and time-consuming cases, such as those involving dementia.”
VA staff physician Ralph Leonard, MD, admits he was
"a bit reluctant" to give up scarce office space to behavioral health providers
(BHPs) at first.
It immediately became clear to him and his staff, however, that the BHPs were a
valuable addition.