Progress ReviewMental Health and Mental Disorders
November 15, 2007 |
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In the 15th session in the second series of assessments of Healthy People 2010, Anand Parekh, Acting Deputy Assistant Secretary for Health (Science and Medicine), chaired a focus area Progress Review on Mental Health and Mental Disorders. He was assisted by staff of the co-lead agencies for this Healthy People 2010 focus area, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institutes of Health (NIH). Also participating in the review were representatives from other U.S. Department of Health and Human Services (HHS) offices and agencies. Dr. Parekh noted that, not so long ago, the subject of mental health was treated as secondary within the larger conceptual framework of health in general. Despite the lingering stigma that, to a degree, is still associated with mental illness, the connection between physical and mental health is now widely recognized as taking many forms, such as depression and heart disease, for example. Also now accepted is the clear linkage between poor levels of mental health and such co-morbidities as substance abuse. Even now, in the first decade of the 21st century, disparities in mental health status persist among certain racial, ethnic, gender, and age groups, and these must be addressed with greater force and determination if they are to be resolved. The complete November 2000 text for the focus area of Healthy People 2010 is available online at www.healthypeople.gov/document/html/volume2/18mental.htm. Revisions to the focus area chapter that were made after the January 2005 Midcourse Review are available at www.healthypeople.gov/data/midcourse/html/focusareas/fa18toc.htm. Additional data used in the Progress Review for this focus area’s objectives and their detailed definitions can be accessed at wonder.cdc.gov/data2010. For comparison with the current state of the focus area, the report on the first-round Progress Review (held on December 17, 2003) is archived at www.healthypeople.gov/data/2010prog/focus18/2003fa18.htm. The meeting agenda, tabulated data for all focus area objectives, charts, and other materials used in the Progress Review can be found at a companion site maintained by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS): www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa18-mentalhealth2.htm. Data Trends In his overview of data for the focus area, Richard Klein of NCHS began by noting the remarkably high prevalence of mental disorders in the United States. According to 2002 data, more than 25 percent of adults aged 18 years and older had at least one mental disorder and approximately 5 percent had three or more. In descending order of prevalence, the four most widespread disorders were anxiety disorders (affecting approximately 18 percent of the population), mood disorders, impulse disorders (among the age group 18 to 44 years), and substance disorders. With regard to the prevalence of major mental disorders among adults, approximately 5 percent had a serious mental illness (SMI) involving role impairment in 2002, about 6 percent had a major depressive disorder, and about 3 percent had a generalized anxiety disorder. Mental disorders are a leading cause of disability, absenteeism, and lost productivity in the workplace. The cost of treatment for such disorders reached $100 billion in 2003. Moreover, the impact of mental disorders is not limited to the mental sphere. Depression, for example, is associated with the development of hypertension, heart disease, diabetes, and stroke. Mr. Klein then examined in greater detail the objectives highlighted during the Progress Review. (Obj. 18-1): The age-adjusted rate of suicide increased from 10.5 per 100,000 population in 1999 to 10.9 per 100,000 in 2004. The 2010 target is 4.8 per 100,000 for all population groups. Among five racial and ethnic groups for which data were available, the age-adjusted suicide rate per 100,000 in 2004 was 5.5 among non-Hispanic blacks, 5.8 among Asians/Pacific Islanders, 5.9 among Hispanics, 12.2 among American Indians/Alaska Natives, and 12.9 among non-Hispanic whites. In 2004, the suicide rate for females was 4.5 per 100,000, compared with 18.0 per 100,000 for males. In general terms, higher rates of suicide occur most frequently in the mountainous western States and in Alaska. (Obj. 18-2): In 1999, 2.6 percent of adolescents in grades 9 through 12 made a suicide attempt that required medical attention, compared with 2.3 percent in 2005. The target is 1.0 percent. The proportion of adolescent males who made such attempts in 2005 was 1.8 percent, compared with 2.9 percent of adolescent females. (Obj. 18-5): The proportion of adolescents in grades 9 through 12 that engaged in disordered eating behaviors (DEBs) decreased from 19 percent in 2001 to 17 percent in 2005. The target is 16 percent for all groups. Among adolescent males, the proportion that engaged in disordered eating in 2005 was 11 percent, compared with 23 percent of adolescent females. (Obj. 18-7): The proportion of children aged 4 to 17 years who received services for their serious mental health problems increased from 60 percent in 2001 to 62 percent in 2006. The target is 67 percent for all groups. The proportion of male children who received such services was 64 percent, compared with 58 percent of female children. Among three racial and ethnic groups for which data were available, the proportions of children receiving such services in 2006 were as follows: non-Hispanic white, 66 percent; Hispanic, 54 percent; and non-Hispanic black, 51 percent. (Obj. 18-4): In 2002, 52 percent of adults aged 18 years and older with SMI were employed (46 percent of females and 60 percent of males). Data on employment of adults with SMI in 2002 by racial and ethnic group were as follows: 54 percent of non-Hispanic whites were employed, as were 50 percent of Hispanics, and 48 percent of non-Hispanic blacks. By achieved level of education, the proportions employed were as follows: 60 percent of adults with SMI who had some college education, 55 percent of adult high school graduates with SMI, and 34 percent of adults with SMI who had not finished high school. The target is 54 percent for all groups. (Obj. 18-9a): In 2002, 62 percent of adults aged 18 years and older with SMI received treatment for their disorders. The target is 68 percent for all groups. By racial and ethnic group, gender, and education level, the proportions of adults with SMI receiving treatment in 2002 were as follows: non-Hispanic whites, 68 percent; non-Hispanic blacks, 51 percent; Hispanics, 45 percent; females, 70 percent; males, 52 percent; those with at least some college education, 65 percent; high school graduates, 64 percent; and those who had not finished high school, 55 percent. (Obj. 18-9b): In 2002, 58 percent of adults aged 18 years and older with depression received treatment for their disorder. The target is 64 percent for all groups. By racial and ethnic group, gender, and education level, the proportions of adults with depression receiving treatment in 2002 were as follows: non-Hispanic whites, 63 percent; non-Hispanic blacks, 43 percent; Hispanics, 42 percent; females, 62 percent; males, 52 percent; those with at least some college education, 59 percent; high school graduates, 57 percent; and those who had not finished high school, 56 percent. (Obj. 18-9d): In 2002, 60 percent of adults aged 18 years and older with generalized anxiety disorder received treatment for their disorder. The target is 79 percent for all groups. By racial and ethnic group, gender, and education level, the proportions of adults with generalized anxiety disorder receiving treatment in 2002 were as follows: non-Hispanic whites, 63 percent; non-Hispanic blacks, 46 percent; females, 63 percent; males, 55 percent; those with at least some college education, 65 percent; those who had not finished high school, 64 percent; and high school graduates, 51 percent. (Obj. 18-3): The proportion of homeless adults aged 18 years and older with mental health problems who received mental health services increased from 27 percent in 2000 to 41 percent in 2005, then declined to 37 percent in 2006. The target, which was first surpassed in 2002, is 30 percent. The survey population was composed of clients receiving social services through SAMHSA’s Projects for Assistance in Transition from Homelessness program. (Obj. 18-6): The proportion of primary care facilities funded by the HHS Health Resources and Services Administration that provide mental health treatment increased from 62 percent in 2000 to 79 percent in 2006, surpassing the target of 68 percent. (Obj. 18-11): The proportion of counties served by community-based jail diversion programs and/or mental health courts for adults with mental health problems increased from 6.9 percent in 2004 to 10.6 percent in 2006, surpassing the target of 7.6 percent. Of the 17 objectives and subobjectives comprised by the focus area, 3 have met or exceeded their targets, 2 are improving, 1 is receding from its target, 5 show little or no change from the baseline, and 6 have only baseline data. Key Challenges and Current Strategies In presentations that followed the data overview, the principal themes were introduced by Kana Enomoto, Principal Senior Advisor to the Administrator/SAMHSA; Richard Nakamura, Deputy Director, National Institute of Mental Health (NIMH)/NIH; and Kathryn Power, Director, Center for Mental Health Services (CMHS)/SAMHSA. Their statements and Progress Review briefing materials identified a number of barriers to achieving the objectives, as well as activities under way to meet these challenges, including the following:Barriers
Activities and Outcomes
Approaches for Consideration Participants in the Progress Review made the following suggestions for public health professionals and policymakers to consider as steps to enable further progress toward achievement of the objectives for Mental Health and Mental Disorders:
[Signed February 21, 2008] |