Surgeon General's Report Lauded

Diagnoses for mental illness are called "reliable" and treatments "efficacious."

Social workers were lavish in their praise of the U.S. surgeon general's report on mental health, which in December placed the need for accessibility of quality mental health services squarely at the top of the national agenda.

The surgeon general strongly urged those with mental disorders or those who think they might have a mental health problem to get help so they can lead productive lives and develop workable relationships.

"The report affirms who we are and what we do as social workers," said NASW's governmental affairs staff member Pat Gorman. "Social workers have made the battle cries over and over — 'We need mental health parity with general health,' 'We need to make services more accessible and comprehensive,' 'We need to destigmatize mental illness,'" she said. "Affirmation by the surgeon general makes this report a very powerful vehicle for gaining public acceptance and change."

The report contains numerous findings, many of which may have been known to social workers but not, heretofore, to the general public.

The report sets out to alter the widespread misconception that mental illness and physical illness are separate. Mental illness stems from physical causes in the brain, it points out, so there is no real split between "mental" health and "physical" health. Mental disorders are real, and mental health is fundamental to health, says the report by Surgeon General David Satcher, written with the aid of experts at the federal Center for Mental Health Services and the National Institute of Mental Health.

Most Americans believe, it said, that society can't afford to view mental health as separate from and unequal to general health. "Mental health should be part of the mainstream of health," the report recommended.

The report found that the diagnoses for mental illness are as reliable as those for general medical disorders, that the efficacy of mental health treatments is well documented and that a range of treatments exists for most disorders.

Well-documented, efficacious treatments include psychosocial treatments, like psychotherapy, and psychopharmacologic treatments, and "often are most effective when combined," said the report.

Based on these findings, Satcher said the foremost explicit recommendation of the report is to "seek help if you have a mental health problem or think you have symptoms of a mental disorder."

Early treatment of mental health problems results in less institutionalization and a healthier and productive society, the report asserted. When treated, people with mental illness can make significant contributions to the economy and society. Untreated, those with mental illness produce negative results for themselves and their families, communities and society.

About 15 percent of the U.S. adult population uses mental health services in any year. Eleven percent receives services from either the general medical care sector or the specialty mental health sector, in roughly equal proportions, the report said. In addition, 5 percent receive care from the human services sector, and about 3 percent receive care from the voluntary support network (the overlap of the two sectors accounts for figures totaling more than 15 percent).

"Bearing in mind that 28 percent of the population have a diagnosable mental or substance disorder, only about one-third with a diagnosable mental disorder receives treatment in one year. In short, this translates to the majority of those with a diagnosable mental disorder not receiving treatment," the report said.

The findings and recommendations of the report blend extremely well with positions taken by social workers and NASW on issues like stigma attached to mental illness and lack of services for the those who need them the most, said Nancy Bateman, NASW senior staff associate.

A major reason for lack of treatment is that mental disorders "continue too frequently to be spoken of in whispers and shame," said Satcher.

Stigma erodes confidence that mental disorders are valid, treatable health conditions and leads people to avoid socializing, employing or working with, or renting to or living near persons who have a mental disorder, said the report.

Stigma deters the public from wanting to pay for care, reducing access to treatment and social services, it said. Inability or failure to obtain treatment reinforces low self-esteem, isolation and helplessness.

Information, policies and actions that reduce the "cruel and unfair stigma" attached to mental illness are crucial, said the surgeon general.

The U.S. mental health system is multifaceted and complex, comprising public and private sectors, general health and specialty mental health providers, and social services, housing, criminal justice and educational agencies, the report said. These agencies do not always work in a coordinated manner.

"Although the hybrid system that exists today serves diverse functions well for many people, individuals with the most complex needs and the fewest financial resources often find the system fragmented and difficult to use," said the report.

A challenge in the near term is to speed transfer of new evidence-based treatments and prevention interventions into diverse service delivery settings and systems, while ensuring greater coordination, it said.

Concerns about costs — concerns worsened by disparity in insurance coverage for mental disorders in contrast to other illnesses — are among the foremost reasons why people do not seek needed mental health care, said the report. When mental health care benefits are increased, access to and use of services increase. Yet there are indications that the effectiveness of mental health care also has increased in recent years, while expenditures for services under managed care have fallen.

"Equality between mental health coverage and other health coverage — a concept known as parity — is an affordable and effective objective," the surgeon general said.

Mental Health: A Report of the Surgeon General can be viewed or ordered at www.surgeongeneral.gov

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Copyright NASW Press, 1998