Mental Health in America: A Report Card

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Mental Health in America: A Report Card

WebMD Live Events Transcript

Former First Lady Rosalynn Carter has spent more than 30 years speaking out for a greater understanding of mental health issues. She joined WebMD Live, along with The Carter Center's mental health program director, Thomas Bornemann, EdD, on May 25, 2005 to discuss the state of mental health care and the efforts to erase the stigma of mental illness in America.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Mrs. Carter.

CARTER:
Thank you, I'm happy to be with you.

MODERATOR:
And we also would like to welcome Dr. Thomas Bornemann from The Carter Center.

BORNEMANN:
Thank you.

MODERATOR:
How common are mental disorders in America?

CARTER:
Mental disorders are very common in America. One person in four families will have a mental illness over the period of a year, so it's very common.

MODERATOR:
We've received many questions regarding insurance parity. Could you please explain the issue of parity in regards to mental health coverage?

CARTER:
Insurance companies do not cover mental illnesses the way they cover physical illnesses. I don't like to make the distinction because there should be no distinction between mental and other illnesses.

There is legislation before Congress to require insurance companies to cover mental illnesses on a par with other illnesses. We have tried very hard to get that legislation passed over a period of at least four years. I think that if everybody who is reading the answers to these questions would write their Congresspeople -- both Senate and House -- and ask them to vote for parity, it would be the best possible thing that could happen to help people with mental illnesses. We have enough votes to pass in the House and in the Senate, but we have not been able to get it out of committee; the Republican leadership is holding it up. I even called President Bush about it a couple of years ago and he told me that he would help get it passed, but it's still languishing.

MEMBER QUESTION:
Has insurance parity passed yet in any state? The additional co-pays and limits on service for mental health treatment are really hurting our family.

CARTER:
That is a bill that was passed in 1996 -- for national coverage. If companies (businesses), covered mental health services for their employees, they had to cover mental health services at the same rate. But what happened was, the insurance companies made co-payments high and the number of visits to the doctor high, so they got around it. They didn't have to cover, but if they did, they had to offer those things -- but they found ways around it.

Some states require insurance companies to provide mental health coverage, but there's no uniformity at all. Most of the time, what the insurance companies will cover, or what these laws require, is very narrow -- for very serious mental illnesses only. The bill before Congress, the national bill, will cover a broader range of mental illnesses, which is what the mental health field wants.

"There was then, and there still is, a great need for mental health professionals who focus on children's mental health."

MEMBER QUESTION:
Parents often have trouble finding a qualified child psychiatrist, or have to wait many weeks for a first appointment. Although the United States is projected to need at least 33,000 qualified child and adolescent psychiatrists, there are now only about 7,000. The Child Health Care Crisis Relief Act (H.R. 1106/ S. 537) will address this shortage. Are you familiar with this legislation? Do you support it? What can we do to get this polarized and paralyzed Congress to pass it?

CARTER:
I do support the legislation.

It's interesting that when we had the President's Commission on Mental Health when my husband was president, the issues were almost the same as they are today. There was then, and there still is, a great need for mental health professionals who focus on children's mental health. This bill will offer incentives to people who are going into the field -- those who decide to study child psychiatry and psychology and become professionals working with children and mental health.

MODERATOR:
My daughter-in-law is currently finishing up her schooling to become a school psychologist. What words of advice would you have for her when she begins dealing with troubled students and communicating with parents?

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CARTER:
I admire her greatly. As we were just talking about, there is a great need for professionals in children's mental health field.

I think her training, of course, has helped her to know how to work with children and their parents. One of the most important things we have learned as we study children's mental health is how very important it is for the whole family to be involved.

Also, school systems are affected. The professionals will have to talk with the parents about informing the school and getting the school to cooperate with them in helping care for the child who is mentally ill.

BORNEMANN:
I would agree. School systems are becoming increasingly recognized by the field as very important locations for early recognition and screening of kids who have special needs.

MEMBER QUESTION:
It seems that teachers will immediately say ADHD when a child "acts out" in the classroom and doctors will quickly prescribe drugs like Ritalin. Shouldn't any diagnosis and treatment be done ONLY by professionals trained to make those calls? What should parents do when they are caught up in this?

CARTER:
I think parents should take the child to a professional; it's very important to have a professional opinion about a child. I agree that medication might be given when it's not needed. I really think the parents should have a professional opinion about it before giving the medication to a child.

MODERATOR:
We've talked about children's mental health issues. Let's discuss mental illness in our aging population. What do we need to know about the care, treatment and any other special concerns as we watch our grandparents and parents aging and not as able to make decisions or communicate well on their own?

CARTER:
My mother was in an assisted living facility the last years of her life. It was very discouraging for me to go to see her because so many of the people there were suffering from depression and needed help. Also, the stigma was so bad, and it is so bad, that it's hard to get treatment in some of the facilities.

I think the best thing to do is to become a little bit educated about the mental health issues and about depression in particular, and see a professional with the parent. It's not necessary for older people to live out their lives in a state of depression and it happens so often.

BORNEMANN:
I think many of the challenges in providing services to children are also there for providing services to our older adults. We don't have enough specialists trained in providing those services and often they are very complex, given frequently the appearance of other kinds of health conditions that may complicate diagnosis and care.

As Mrs. Carter mentioned, depression is terribly under-recognized in older adults and is generally quite treatable. Treatment can often lead to better outcomes for not only the depression the person may be experiencing but better outcomes for other health conditions they may also be experiencing.

MODERATOR:
The Carter Center is working hard to help erase the stigma of mental illness. Can you give us a few examples of how?

CARTER:
One of our best programs, and I think it's helping a lot with things, is our Fellowships for Mental Health Journalism. We decided that since the media has such an impact on the way people view mental illnesses and the way they feel about people with mental illnesses, that if we could develop a cadre of journalists who knew the issues and can report accurately and also have some influence on their fellow journalists, that maybe it could be very helpful.

We have had about seven classes. We give journalists a stipend. They apply for a fellowship with a subject, and they work a full year on the subject that they declare. They come to the Carter Center and talk about what they are going to do and come back at the end of the year and report. We have six from the United States, two from New Zealand, two from South Africa -- we have gone international. The stature of those who apply has been, from the very beginning, really wonderful -- from the major news magazines and television journalists, major press journalists. It's been a great program.

I really believe the stigma is beginning to lift a little bit across the country and it's because people are beginning to become more educated about mental illnesses. Over the last few years, because of research and our new knowledge of the brain, mental illnesses can now be diagnosed; they can be treated effectively and the overwhelming majority of people with these illnesses can live normal lives -- living at home, working and going to school.

What we have learned from research is that mental illnesses are diseases of the brain. It's all biological, and there should be no shame and no embarrassment if a person has a disease of the brain. No more than the person who has a disease of the heart or any other part of the body. And as people learn that, I think the stigma is beginning to lift. We have a long way to go, of course, but I do think things are a little bit better.

"The most exciting thing today is that recovery is possible. When I first began working in mental health many years ago, we never dreamed people could recover from mental illnesses and that's because we didn't know anything about the brain."

MEMBER QUESTION:
Don't many people stay silent about their mental health issues in fear that they may lose their job or that their child will be treated differently in the classroom if they are open about it?

CARTER:
That has absolutely been the case in the past and it's still the case in some instances.

I had one woman tell me that she had a job and she had developed a mental illness. She was treated and had it totally under control, but when she went back to work and when she was walking down the hall or if somebody saw her coming -- they would turn and not face her. This was not because they didn't like her -- they just didn't know what to say to her. Now, that's fairly mild compared to the way some people are treated because of the stigma.

I think the younger generation is accepting it. People are beginning to accept it more, particularly the younger generation. I think things are getting better.

BORNEMANN:
I would like to add, I think it's important, though, where people are treated in a discriminatory way by virtue of the health condition, they should challenge that. They are often protected under legislation such as the Americans with Disabilities Act. It is a form of discrimination.

MEMBER QUESTION:
What can you do to help a family member who is showing signs of mental illness?

CARTER:
Take them to a professional for evaluation. It is very important to detect a mental illness early and have it treated. I think the most important thing anybody with a family member that may have a mental illness, is to see a professional.

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Today with the new medications and the new treatment methods and because of what we have learned about the brain, people can be helped. The earlier they get the help, the easier the illness is to be controlled. Some can even be cured. I think sometimes a person can have a bout of depression and not ever have another one.

BORNEMANN:
That's correct. With our new treatments that are available today, both medications and also the psycho social treatments, including assisting people in returning to every day life and jobs and school and such, there's great optimism that we didn't have 20 or 25 years ago.

CARTER:
The most exciting thing today is that recovery is possible. When I first began working in mental health many years ago, we never dreamed people could recover from mental illnesses and that's because we didn't know anything about the brain. We had no knowledge of mental illnesses. But today recovery is possible and we're even beginning to think about prevention. Great, dramatic changes have been made, and this has all happened in a very short time.

MODERATOR:
What can be done to educate us -- the general public as well as the friends and family members of people with mental illness -- in becoming better advocates, decision-makers, caregivers and consumers?

CARTER:
Educate people about mental illness -- talk about it, let them know that there should be no shame or embarrassment about people with mental illnesses.

And I think research has shown that what takes the stigma away even more than having well-known personalities talk about their mental illness, is for a friend or a neighbor that they have known or worked with for years to admit they have a mental illness. That seems to blow away the stigma when that happens. I think the best thing we can do is just talk about it openly.

BORNEMANN:
I think you're on the right path. It is to talk about it openly when people are able to feel comfortable in disclosing their illness and putting a face on it, that these no longer become abstractions but become our family members, our friends and our colleagues. That is when the stigma begins to diminish.

CARTER:
And also when people learn about a disease or have some idea of why things happen, like with cancer, the stigma goes away. Cancer, for instance -- nobody talked about cancer. My husband's father had cancer. He had surgery and found that he had cancer, but it was never spoken. I don't know that he ever asked what it was after the operation but nobody ever mentioned it, and now it's totally open. This is what my hope is, and I really believe that's going to happen because you can already tell that the stigma is lifting a little bit.

MODERATOR:
I'm afraid Mrs. Carter has to leave us now, but Dr. Bornemann will stay with us through the end of the hour. Thank you for joining us today, Mrs. Carter.

CARTER:
Thank you, I've enjoyed it. Thank you for doing this program, it's really important I think.

MEMBER QUESTION:
Dr. Bornemann, is there any direct link to mental disorders being hereditary?

BORNEMANN:
Yes, there's a body of evidence that suggests a number of mental disorders will have some genetic components to them. That's one productive area of work that's growing in recent years, and we're learning more about genetic influences. Certainly we'll learn more as the projects related to the human genome continue to develop.

MEMBER QUESTION:
How do you take someone to a professional if they don't want to go or refuse to admit they even have a problem?

BORNEMANN:
That's a great question and a very challenging dilemma. I think what is very useful, particularly if it is someone you're close to, is to tell them about how concerned you are about them -- to express that openly and honestly. Many times we tend to tip-toe around what we see and it's often comforting and helpful to the other person to be direct with them about what you see and what your concerns are about. And then offer them a solution. I think it's important when you do have this kind of a difficult conversation with somebody you care about, that you have done a little research in advance, and hopefully have some resources at hand that they might be able to access.

"I think it's important that we explode the myth that mental disorders are a result of moral failings or some other inadequacy of the person instead of what they are and that is health conditions that require effective care and resolution."

MODERATOR:
When primary care physicians do prescribe medication -- for depression as an example -- don't they usually also include information about mental health follow-up visits and referrals to specialists?

BORNEMANN:
This is a very important question and a very important area of work that we're learning a lot more about. In fact, it is a program area that we're exploring here at the Carter Center.

Most people who seek mental health care will initially seek it from their primary care provider. They are a very important link in the chain of treatment and recovery. Unfortunately, many primary care providers are not well trained in the special needs of people with mental illness, but that's not universal, there are some who are very good at doing it.

There are a number of models that have been developed over reason years on how to identify and recognize mental illnesses in the primary care environment, and how to more effectively get people into the level of care they need. Many people can be simply treated in the primary care environment, but some will need to be referred on.

There are models out there that have been developed by foundations such as the MacArthur Foundation, the Robert Wood Johnson Foundation and the Hartford Foundation, that have demonstrated a very effective ways of managing particularly depression, which is one of the most common mental illnesses identified in primary care. We have the models available on how to do that well.

MEMBER QUESTION:
One downside to the increased acceptance of mental illness, ironically, is that those who still stigmatize it think depression, ADHD, and other common problems have become "trendy" and that doctors are just throwing pills around to anyone. Your thoughts?

BORNEMANN:
Mental illnesses are real -- the surgeon general's report in 1999 identified that very emphatically. There are diagnostic methods available to clearly diagnose conditions and treatments available to help people get better. It fits all the criteria of any other kind of health condition.

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I think it's important that we explode the myth that mental disorders are a result of moral failings or some other inadequacy of the person instead of what they are and that is health conditions that require effective care and resolution. I think it's important that we attack those myths when we see them, whether it's what we have done with our journalism program in the press, or with our friends, neighbors or colleagues at work when people make disparaging remarks about crazy or psychotic, or throw around diagnostic terms like schizophrenia to define a set of behaviors that are completely outside the mental health realm. I think it's those kinds of demeaning remarks that both minimize and trivialize serious health conditions.

MEMBER QUESTION:
How do we recognize mental illness in ourselves and in our families?

BORNEMANN:
Another fine question. We begin to realize it when we see that life as we know it is changing -- that we're not able to concentrate, we're not able to function as well as we were. Perhaps we will have a sleep disturbance or maybe a change in appetite. It is when we start seeing these kinds of changes -- changes in our normal everyday life both in terms of the biological functioning such as in our appetite and sleep which are often good indicators that something is amiss, but also in our mood, our ability to relate to others, our enjoyment of the normal surroundings. Do we engage with people we care about? Are we argumentative when we're not normally that way? Do we see subtle changes in our personality, or maybe more dramatic changes? Do we see a slippage in our work performance or school performance or perhaps a new inability to handle our everyday tasks? Those are the clear warning signs that something is amiss and that we may need to take a look at it.

Often one of the best ways to do that is to listen to those who care about you, close family members, but also to perhaps see your family doctor. It may be explainable by other kinds of health conditions, but it may not be. And if not, hopefully that person can help you unravel what's going on and get you into the right treatments that you may need.

It is a similar description for family members. When you observe those kinds of changes in your family members, I think the first order of intervention is to mention that to them, that you have observed this change and that you're concerned about it. And if you're concerned enough about it, you suggest that they see somebody about it and maybe even offer to accompany them when they take care of it.

MEMBER QUESTION:
What can each of us do in our daily lives to help combat the stigma? It seems such a private matter.

BORNEMANN:
Early studies of stigma suggest that it starts at a very early point in our life as we begin to learn language and watch the behavior of adults. What we have learned in the last 20 years, and much of it learned from those people who experience mental illnesses, is that language is important. It's important for all of us to not engage in frivolous use of potentially hurtful terms. Terms like "crazy" can be very hurtful to people who are experiencing a mental illness, and may further enhance their concerns about how other people are going to perceive them as a result of their illness.

Stigma comes from often ignorance, sometimes fear and other kinds of conditions that can be fixed with education and with reaching out and talking with people who have these kinds of conditions.

There are a number of wonderful organizations out there for people with mental illnesses, for family members, and for others who care about these issues, such as the National Mental Health Association, the National Alliance for the Mentally Ill, and a number of other organizations that are oriented towards assisting people in learning more about illnesses and how to manage them effectively.

It is both an issue of education and intervening when you see these misuses of terms and pejorative language to describe people who are experiencing a health condition.

"We have found striking examples of horrible reporting, inaccurate reporting, the use of inflammatory language in reporting, blazing headlines over people with mental illness committing a crime. These kinds of misuses of the public press contribute immensely to public perceptions of people with mental disorders."

MEMBER QUESTION:
What do you think of consumer-run organizations like we have here in Kansas?

BORNEMANN:
I think that they are one of the more important innovations that we have had in the last couple of decades. The appearance of active consumer-run organizations has been a real major addition to the mental health community. There can be no stronger voice about mental illness than those who experience one. I think that they have contributed enormously towards making services more meaningful, more appropriate and more sensitive to the wide range of needs that persons with mental illnesses have. For example, we no longer are thinking of people with mental illnesses as a diagnosis, as a schizophrenic -- they are a person struggling with schizophrenia -- they are a person first. Consumers have taught us that over these many years. Their contribution has been enormous and continues to be enormous.

MEMBER QUESTION:
In regards to your journalism fellowship program, how do you think journalists can reduce stigma? Why journalists?

BORNEMANN:
Most of us get our information in one form or another from the media. We have found striking examples of horrible reporting, inaccurate reporting, the use of inflammatory language in reporting, blazing headlines over people with mental illness committing a crime. These kinds of misuses of the public press contribute immensely to public perceptions of people with mental disorders. For example, a widely held source of stigma that many people hold is that people with mental illnesses are a danger. The evidence simply does not support that in the broadest terms. There are some conditions that may involve somewhat more incidences of violence but they are very few, very limited and the vast majority of people who experience a mental illness are not dangerous to anyone. Yet if you would look at some of the press reporting, you would tend to think that virtually anybody with a mental illness may potentially be irrational or dangerous and that's simply not true.

Our program is designed to assist journalists in writing accurately and to understand better how their use of language can be very important in uncovering these myths and these misstatements about mental disorders and the people who experience them. So far, our work suggests that they can be highly effective spokespersons in explaining the experiences of mental illness and particularly from the voices of those who actually have those illnesses.

MODERATOR:
Television, newspapers and other media do seem to reinforce the misconceptions and stereotypes of mental illness. Have you seen improvement as more people in the entertainment industry have become educated in the reality of mental illness -- or do we still have a long way to go?

BORNEMANN:
I think we have a ways to go, but I think there have been significant improvements. There are a number of people in the media now who regularly check in with organizations like ours to ask about the best way to handle a certain situation. There are script writers now who have become more careful in how they portray illnesses in dramatic roles. These are really terrific advances. Some colleagues at George Washington University have been working on it in the entertainment media, and we have been working on it in the news media. I think there has been a great improvement. But yes, we do have a long way to go.

MEMBER QUESTION:
With proper diagnosis and treatment, can those with mental illnesses lead normal, happy, productive lives?

"Learn what's going on in the public policy arena, educate yourself about it, and act."

BORNEMANN:
They sure can and that really is the "good news" message. With proper diagnosis and services, most people who experience a mental illness can resume their lives and live well with their mental illnesses. They can return to work, continue to function in their families and in their communities, pay taxes, etc. We have seen over and over again the inspiring stories of how people with mental illnesses manage their everyday lives.

We must remember that it's estimated that over 80% of people who, for example, experience depression, one of our most common mental illnesses, go to work every day or function in a role -- over 80%. That means most people are already attempting to negotiate their life while living with this illness. You probably have someone in the next office from you, and you don't even know it.

MODERATOR:
Dr. Bornemann, we are almost out of time. Before we wrap things up for today, do you have any final words for us?

BORNEMANN:
I would like to thank you for giving us the opportunity to interact with your audience. The questions were superb and I think they reflect the kinds of concerns that most Americans have. We have appreciated the opportunity to lend our voice to making sure that our entire nation knows how important these issues really are, how very prevalent these disorders are, and how treatable they are.

It's important for all Americans to recognize that when we have barriers to providing better services for all Americans, that we do something about them -- like our parity problem that we have right now in this country. This is a tragedy. There is no science to explain why we discriminate against mental illnesses as opposed to other kind of illnesses. The evidence is compelling that it won't even cost much more -- if at all -- to provide full and complete coverage for mental disorders, yet we don't have it in this country.

I appreciate the opportunity to talk about these issues, and urge your audience to please be aware of them. Learn what's going on in the public policy arena, educate yourself about it, and act.

MODERATOR:
Our thanks to Mrs. Rosalynn Carter and Thomas Bornemann, EdD for joining us today. To learn more about The Carter Center, visit their web site at www.cartercenter.org and please read Helping Someone with Mental Illness , by Rosalynn Carter.



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Reviewed on 6/17/2005 5:55:36 PM

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