So this is the 20th anniversary since Congress first established Mental Health Awareness Week as the first week in October.
The effort to increase awareness about mental health is based in the history of numerous government reports and well-meaning workgroups and such that have found that stigma still exists surrounding the diagnosis of mental disorders. Surprise, surprise. Of course it still exists. People who’ve never encountered someone living with a mental illness still believe it’s the kind of thing that “happens to other people.”
But it happens to a lot more “other people” than anyone realizes. In our lifetime, 1 in 5 Americans will have a diagnosable mental disorder. And the Centers for Disease Control and Prevention just announced last week that the 12 month prevalence rate for depression stands at 9 percent. That means in any given year, 1 in 10 Americans suffer from the most common mental disorder, depression.
That’s a lot of depressed people.
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The prevalence rate of mental illnesses is alarming and for many the untreated prevalence is even more alarming. Yet as you say “…Left untreated depression will resolve itself over time…”. Maybe some get better or feel better before they go to treatment? Similarly, many may respond with “some of the time” or “most of the time” on the Kessler 6 but his may not reach their threshhold for needing to seek help. Again, some days are better than others. Finally, there are many who get help from their family, teachers, ministers, friends and other informal caregivers or allied health providers. For them, this form of peer support and wellenss intervention may in fact alleviate symptoms and reduce the need for professional care. Still others are receiving medication and other support from their primary care physician not coming into specialty care.
All of which suggests that we don’t really know what the right untreated prevalence rate is. Do we? Its not like cancer where we want 100% of the diagnosed prevalence to have some form of treatment. Diabetes, has 20% of the prevalence rate undiagnosed/untreated, suggesting similar rates in other diseases.
Our rates of positive outcome from medication, therapy and a combination of the two (70-75%) are better but not much better than placebo (60-65%). Our rates of improvement for therapy alone are roughly equivalent to the medication improvement rates. All of which suggest that we should do whatever is the least expensive and intrusive intervention early and step it up as needed. I am not sure that is always the prevailing practice.
We need to work together to tighten up our data and develop protocols for the level of our interventions so they are matched to the needs of our clients. Mental health awareness week should remind all of us in the field of the importance of this too!
Sadly, “The problem with clinical depression is that treatment often is ineffective. Only 5.8% of patients with clinical depression have symptom remission within six months of treatment, according to a Minnesota study of 184 primary care and behavioral health clinics conducted by MN Community Measurement, the state’s public reporting agency.” (Psychiatric Services, October 1, 2010, 1042-1044)
Thank you for this excellent article. We need to keep talking about the prevalence of depression in our society.
Traumatic events often bring on depression. PTSD and depression can go hand-in-hand. As one who has experienced this firsthand, I know the relief that can come with the proper diagnosis and treatment.
Today there are many resources available that can increase one’s quality of life. We’re lucky to be living in a time when this is so. Let’s continue working to erase the stigma that still remains on mental health issues.
The incidence of depression and anxiety disorders in our culture is alarming, yet there does not seem to be a proportional response at the national level to support research into promising new psychotherapy approaches such as Mindfulness-based Cognitive Therapy. We need new innovations if we are to get on top of this problem.
Mental illness is not just something which only affects the less privileged and poor, it also affects those who are rich, educated and privileged. The problem is greater because no one wants to admit there is anything wrong.
The saddest part however is that very few people know are aware when a person is mentally ill or not. This is the case in Pakistan. Rich and poor alike suffering from a whole range of mental illnesses, there are very few psychologists. People often mistake psychologists for psychiatrists and all this because no one knows the difference and no ones knows what exactly a psychologist does.
I am all for this campaign to make more people aware of mental illness’s and even glad that many schools and communities are offering free depression screening this week. My problem with all this is that no one has come forth offering affordable help to those with mental illness. Even if you are insured treatment can and often does become a financial burden on individuals and families thus creating even more problems. I have been treated for depression and bi-polar disorder for years. Have tried every generic drug available for depression, and found that the only drug that actually works for me is Cymbalta. There is no generic of Cymbalta and it is very expensive. I am not insured. I work but do not make enough to afford insurance, doctor visits, or my medication. Still have have been lucky enough that my wife has insurance and has been able to get my meds by lying to her doctor. But that isn’t going to last much longer because her doctor now wants her to see a psychiatrist to get my Cymbalta. That mean I will not be able to get the medication I need and I will go through withdraw and eventually sink back into a major depression with no treatment. And if history repeats it’s self I will once again be hospitalized in the psychiatric wing of our county hospital racking up huge medical bills or I will be dead leaving my family to pick up the pieces and the cost of my funeral and cremation (because a burial is too expensive.)
So I hope I have made my point. Diagnoses is all fine and dandy as long as affordable treatment is available.