In the Public Interest

U.S. Surgeon General, David Satcher, MD, PhD, has given the nation a wonderful present with the release of the first ever report on mental health issued from his office.

Mental Health: A Report of the Surgeon General was released six months after the first ever White House Conference on Mental Health, which provided needed momentum of consumers, families, professionals, scientists and others who desire to improve the nation's mental health system and move its policy agenda forward.

The timing of the Surgeon General's report, coming toward the end of the 20th century, also allows it to serve as an important marker, indicating the accomplishments, status and needs of the system as it enters the next century.

Who should read it?

The Surgeon General's Report on Mental Health is written with the various mental health constituencies in mind. Primary consumers of mental health services and their families will likely appreciate the report's emphasis on the realness of mental illnesses and affirmations that interventions exist that provide hope for rehabilitation and recovery.

Scientific and professional audiences are likely to resonate to the rich research and evidence-based nature of the report, while informed persons in the mental health community are likely to recognize its findings. Few in these communities are likely to find much that is new. Psychologists, in particular, and other social and behavioral scientists, will find their research cited throughout the document. Many APA members contributed to the report.

Hopefully, the report will have its greatest impact outside the mental health community, in the general public. Although the mental health community may find little that is new in the report, it nonetheless will likely bring to the general public a higher level of understanding about mental health and mental illness. The imprimatur of the Surgeon General will make the report's information credible and help to increase the public's understanding and lessen the fear and stigma associated with mental illnesses. In addition, the message that mental illness is real, that effective treatments for it exist and that recovery is possible should lend hope. Many people are still unable to accept treatment for mental and emotional disorders because they fear such a diagnosis and treatment will bring embarrassment and shame to them and their families. The Surgeon General's message may assist in acceptance and care of those with mental illness.

Last, but clearly not least, the Surgeon General's report offers important messages for the policy-makers whose decisions ultimately determine accessibility and availability of resources for research, treatment and rehabilitation of persons with mental health problems. The report firmly advocates for parity of mental health benefits with those of general health, citing evidence from those few instances in which parity has been attempted. Policy-makers are also likely to be interested in consumer rights, such as privileged communications and provision of informed consent in mental health settings.

Concerns

The Surgeon General's report is comprehensive in scope and addresses important mental health issues. Some of these issues are problematic for the system and could use further discussion.

A few examples:

  • Managed care is treated with great objectivity, but the adverse impact of behavioral health care on consumers and providers needs to be addressed in some detail.

  • People of color are not forgotten in the report, but the immense problems posed by their growing numbers and the mental health system's slowness to act is understated throughout.

  • The growing numbers of mentally ill people who also abuse legal and illegal substances received only brief mention in the report.

The Surgeon General's Office has made promises that these and other im- portant matters will be addressed through development of supplements to the report, some to be made available in 2000.

The Surgeon General's report is available on the Internet at www.surgeongeneral.gov. Copies of the report and the executive summary are also available by calling 1-877-9MHEALTH.

Further Reading

See the February Monitor for a question-and-answer session with the Surgeon General.