The stigma attached to seeking mental health services remains a significant problem, said retired Army Capt. Stefanie Pelkey at a March Capitol Hill forum, which included members of President Bush's 2002-2003 New Freedom Commission on Mental Health. Pelkey, the widow of an Iraq war veteran who committed suicide a year after returning home, said that more proactive intervention services would have saved her husband, Michael, who had severe post-traumatic stress disorder (PTSD).

"Until the senior leaders of our country start recognizing these deaths outside the theater of operations, soldiers will not want to come forward with their own battles of PTSD," asserted Pelkey at the March meeting. The meeting was convened by the Campaign for Mental Health Reform, a coalition of 16 national mental health organizations, including APA, formed in 2003 to make mental health a national priority and to develop specific action steps to achieve the commission's recommendations In fact, both the Campaign for Mental Health Reform and the Substance Abuse and Mental Health Services Administration have disseminated detailed action agendas based on the commission's work.

At the meeting, a nongovernmental convening of former members of the commission to examine pressing national mental health issues, commissioners listened to the testimony of Pelkey and other mental health consumers and professionals who, in addition to discussing returning war veterans' mental health, examined the steps that various government and advocacy organizations are taking to address the the national crisis of suicide, and ways that employers can improve mental health services in the workplace. The commissioners also assessed the state of the nation's mental health three years after their report was issued and discussed how to achieve the report's goals. In attendance were APA members Stephen Mayberg, PhD, and Deanna Yates, PhD, who along with APA member Larke Nahme Huang, PhD, had served as commissioners.

Reforming the system

In April 2002, President George W. Bush established the commission as part of an initiative to eliminate inequality for Americans with disabilities. The commission's mandate was to identify policies that could be implemented by all levels of government to make the most of existing mental health resources; improve treatments and services; and promote the reintegration of adults and children with mental health problems into society. The 22 commissioners were drawn from private and public sectors across the country and met monthly from June 2002 to April 2003. In May 2003, the commission issued a report that declared the nation's mental health system fragmented and broken. The commission's recommendations included the creation of a national campaign to reduce the stigma of seeking mental health care, the development of a national strategy to prevent suicide and the adoption of parity for mental health, wherein it is treated with the same urgency as physical health.

Returning war veterans and trauma

In line with Pelkey's testimony at the event, a study the Department of Veterans Affairs (VA) conducted with the Walter Reed Army Medical Center indicates that 18 percent of veterans who served in the Iraq war and 13 percent of veterans of the Afghanistan conflict suffer from PTSD. In fact, according to Frances Murphy, MD, VA undersecretary for mental health issues, the VA saw a 30 percent increase in the diagnosis of PTSD from January to March. In response, the VA is implementing more outreach programs to educate veterans about trauma and treatment and is increasing screening and the availability of mental health programs on military bases, Murphy said.

Suicide as a national crisis

An average of 31,000 people each year commit suicide--about 85 people each day, reported psychologist Ileana Arias, PhD, director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, which is using a variety of new tools to collect data it hopes will help prevent and better understand suicide. Among them are the National Electronic Injury Surveillance System, which involves a nationally representative sample of U.S. emergency departments, and the National Violent Death Reporting System, which links data from death certificates, police reports, coroner and medical examiner records and crime lab reports.

More education is also needed to remove the stigma attached to talking about suicide, said Jerry Reed, the executive director of the Suicide Prevention Action Network. Since the New Freedom Commission report, all but a few states have implemented active suicide-prevention programs. This year, 22 colleges, 13 states and one tribe received the first youth-suicide prevention funds under the 2004 Garrett Lee Smith Memorial Act, a law successfully advocated for by APA.

Mental health in the workplace

Health and productivity costs in the workplace are up: Sick leave increased by almost 100 percent between 2002 and 2004, reported Ron Finch, EdD, director of prevention and health services for the National Business Group on Health, an association that represents 245 big businesses, including 62 of the Fortune 100. Finch and commission member Henry Harbin, MD, presented findings from a National Business Group on Health study that found the top two issues affecting productivity are stress and family issues. Depression and other mental health problems cost big business an average of $17 billion in disability pay and $217 million in lost work days, and the costs continue to increase, explained Finch. Untreated behavioral health problems are also driving up physical health costs, underlining the need to focus on mental health issues, continued Finch.

The study recommends a number of actions to make treating physical and mental health less costly and more effective. These include equal coverage for mental health treatment and requiring national best-practices guidelines for health-care providers. Employers should require more accountability and require that their health-plan providers document diagnoses, screen for mental health problems in those at-risk and refer employees to mental health providers, Harbin concluded.

Behavioral health care should focus on prevention and recovery from serious mental illness, asserted Nada Stotland, MD, Rush Medical College psychiatry professor and the vice president of the American Psychiatric Association. Employees need access to screening, assistance and mental health care for their families, she said. The integration of mental health and other medical care is also important, Stotland said, urging that behavioral health services must be provided for as long as it takes for people to make a full recovery.