Cover Story

Mental health and the role psychologists can play in promoting it have become a top priority for the U.S. Surgeon General's Office.

In December, psychologists' calls for increasing access to mental health services and furthering research on mental disorders got a sizable boost with the release of the first-ever U.S. Surgeon General report on mental illness. And Surgeon General David Satcher, MD, PhD, is fully backing the report's conclusions that support the role of federal and state governments in promoting parity for mental health services and in implementing mental health awareness campaigns to decrease the stigma of mental illness and encourage people to seek treatment.

"Mental Health: A Report of the Surgeon General"--a culmination of an extensive review of mental health research--concludes that while about one in five Americans has a mental disorder, most never seek treatment despite the availability of effective treatments. Often impeding their care, says the report, is a lack of insurance coverage and fear of the stigma attached to mental illness.

The Surgeon General's most important message to the American public is straightforward: Seek help if you have a mental health problem or think you have symptoms of a mental disorder.

APA's Public Policy Office contributed to the development of the Surgeon General's report on mental health by commenting on the initial outline, by providing feedback at briefings and meetings with those involved in its preparation, and by highlighting psychological research in key areas. The office also facilitated the participation of a number of APA members among those included in the list of contributors on page 23.

A week after the report's release, the Monitor visited with the Surgeon General to ask about the report's conclusions and his office's next steps.

Q. Your report recognizes that Americans need to pay more attention to mental health promotion and the prevention of mental illness. However, there aren't many federal initiatives or programs along those lines. Do you have plans for such programs in the future?

A. It's fair to say that this report is really more about mental illness than it is about mental health. The reason for this is that I don't think we know enough about mental health and how to prevent mental illness. That's one of the major things we hope will come out of this report--a major push for research and prevention of mental illness and the promotion of mental health. We need to continue the science, [and with that] I think you're going to see much more effort in that area over the next few years.

Q. The report also states that medication, along with psychosocial intervention, allow us to treat most mental disorders. However, managed-care companies most often only cover medication, because they see it as less expensive. How can we ensure that psychosocial intervention, not just medication, will be available to people who need them?

A. One thing we need to do is show the cost-effectiveness of psychological interventions. There are studies in the report that show that when you don't provide access for mental health treatment, people who have problems with depression or anxiety, for example, express those problems in other ways: lower back pain, abdominal pain, chest pain, headaches. But people don't think the system is receptive to dealing with underlying problems, like anxiety or depression, and they're not encouraged to talk about those things.

Another goal is to ensure parity for mental health services on the state and national level. Just since the report came out, there have been states in which parity legislation has been introduced. And at least 28 states have already passed parity laws. Unfortunately, they're not all equal, but I think we're making progress.

We also need to keep evaluating the impact of parity laws. We've got to be able to show that when you approach mental health as you would any other illness in terms of reimbursement and coverage, in the long run it pays off for individuals, families and the community. And it's not a bad investment for the nation or for health plans.

Q. The federal government is beginning its program of providing mental health parity to nearly 10 million federal employees. Will there be any evaluation of how parity is working--for example looking at whether more people are being covered for mental health problems?

A. That's what we're talking about right now. The implementation of the program will probably be delayed for a year. So, we have time to plan now to do a really good evaluation. It's a tremendous opportunity.

Q. Related to the supply and demand of psychologists, has your office done any studies to determine how many mental health professionals are needed to meet consumer needs, and what the projection might be for the future?

A. That was not included in this report. But what is included is the need to increase the supply of mental health service providers, and that includes psychologists and psychiatrists, as well as psychiatric nurses and primary-care providers. So many people who access the system see family physicians, internists or pediatricians for mental health problems--they're on the front line, and the role they could play in early detection and treatment or referral could be a great addition. They've got to be attuned to that, and it's got to become a greater part of their training, whether you're talking about undergraduate, medical school, nursing school, graduate education or continuing medical education.

Q. How can we foster more interdisciplinary collaboration?

A. It is critical to develop partnerships among the disciplines. We're talking with the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics and others about developing partnerships with APA and other groups [concerned about mental health] to raise the level of care for people with mental illness.

Q. One of the report's major themes is reducing stigma. In addition to educating and informing consumers, how else can psychologists reduce the stigma of mental illness?

A. Well, there's no substitute for public education and public awareness. I think the most important message in this report is the science--the fact that mental illnesses are real, that they have a physical/chemical basis--in essence, mental illnesses are physical illnesses. That message, when carefully, accurately communicated, will do more than anything to remove the stigma.

The other message that will help is that many mental illnesses are treatable. People can be returned to productive lives and positive relationships if they're treated appropriately.

Now, how do you convey those messages? That's why we're talking about the destigmatization campaign. Recently I visited Australia to examine a campaign they started back in the early '90s that is not just public education, it's public motivation. They've used vignettes on TV to show cases of people with mental illness who've been treated and returned to productivity right alongside people with diabetes who've had their diabetes controlled. They're making the point that just as diabetes can be diagnosed, treated and controlled, so, too, can mental health problems. That's the kind of effort we need in this country.

Q. We hear that you're planning to do several supplements to the mental health report. When will they be out and what are the topics?

A. The first supplement will examine the effects of race, culture, ethnicity and maybe even gender on mental health. We're talking about releasing that in three to six months. We're also interested in a supplement dealing with the elderly that will be ready by summer.

Another topic that people are interested in has to do with the unique role of the provider in mental health services. The doctor-patient relationship is important in any field, but many people feel that there is a special requirement of that relationship in dealing with mental illness.

And we're talking about working on a full-blown Surgeon General's report on substance abuse and treatment of addictive disorders, which could be released in the next two years. The Substance Abuse and Mental Health Services Administration is raring to go with that.

Q. Is there anything else you'd like to say to the nation's psychologists?

That doesn't happen by chance, it happens by planning and organizing and partnering. And that's what I hope we're going to do--we're going to come together across disciplinary lines in the interest of mental health and organize strategies for destigmatization, but also for substantially improving treatment and access to treatment and mental health services.

A lot of thought has gone into how we get the message out there. This was not meant to be a report to be on a shelf. It's meant to be a report to push to the American people.

Further Reading

The Surgeon General's report is available on the Internet at www.surgeongeneral.gov. The full text of the executive summary will also appear in the February issue of APA's Professional Psychology. Copies of the report and the executive summary are also available by calling 1-877-9MHEALTH.

CONTRIBUTORS

APA's Public Policy Office facilitated the participation of many APA members who contributed to the report. Their names are listed below. In addition, research of numerous other psychologists was cited throughout the report.

Norman Abeles, PhD
Catherine Acuff, PhD
Leonard Bickman, PhD
Jeffrey A. Buck, PhD
Barbara J. Burns, PhD
Robert Friedman, PhD
John J. Gates, PhD
Mary Harper, RN, PhD
Kevin Hennessy, MP, PhD
Mario Hernandez, PhD
Miriam Kelty, PhD
Christopher Langston, PhD
Steven R. Lopez, PhD
Alicia Lucksted, PhD
Ann Methews-Young
Jeanne Miranda, PhD
Abram Rosenblatt, PhD
Lonnie Snowden, PhD
George Stricker, PhD
Stanley Sue, PhD
Joanna Tyler, PhD
Joan Ellen Zweben, PhD