White House seeks renewed focus on mental illness

After several recent highly publicized fatal mass shootings and reports of an alarming number of suicides by U.S. veterans each day, the White House launched the first national conference on mental health in 14 years.

The purpose of the June 3 event was starting a national conversation about mental illness to reduce stigma and improve early identification of mental health conditions. Participating in the conference were more than 200 mental health experts, members of Congress, primary care physicians and celebrities.

Mental illness has received increasing public attention, partly because the alleged perpetrators in recent mass shootings were reported to have mental health problems. President Obama, however, spoke very little about violence.

“The overwhelming majority of people who suffer from mental illness are not violent,” he said.

But most suicides involve someone with a mental health or substance abuse disorder, he added. “And in some cases, when a condition goes untreated, it can lead to tragedy on a larger scale.”

Former President Bill Clinton kicked off a similar national conversation in 1999 after the fatal Columbine High School shootings in Littleton, Colo., that occurred during April of that year, said Thomas Insel, MD, director of the National Institute of Mental Health.

At the June event, Obama called for more open dialogue about mental illness among the public and the medical community, so people with mental health conditions feel comfortable seeking help rather than “suffering in silence.”

He urged health professionals to identify and treat mental health conditions early, just as they do for cancer and diabetes.

“Less than 40% of people with mental illness receive treatment,” Obama said. “We wouldn’t accept it if only 40% of Americans with cancers got treatment … [or] if only half of young people with diabetes got help.”

The White House event was viewed by some doctors as an important step to improve the nation’s mental health care, but they agree that more is needed to make effective, lasting change. Among them was James M. Perrin, MD, president-elect of the American Academy of Pediatrics.

Dr. Perrin, who participated in the national conference, described it as a great starting point. But, he said, “We need to go further and develop a plan that brings mental health into the same parity as other parts of health care.”

Action plan priorities

The plan needs to address broad, complicated issues such as the payment system, which prohibits most primary care physicians from getting paid for a mental health diagnosis, said Dr. Perrin, professor of pediatrics at Harvard Medical School in Boston.

Another key focus of the plan should be early identification of mental health problems, which can be achieved, in part, by primary care doctors making small changes, Dr. Perrin said. Such changes could include physicians taking courses on how to identify early signs of common conditions, including anxiety and depression.

He said doctors also should create an environment in their practice where patients feel comfortable discussing their emotional and mental health, by offering pamphlets in the waiting room and hanging posters on the wall that discuss mental health issues.

To help primary care doctors better address such issues, the American Medical Association is partnering with the American Psychiatric Assn. to disseminate educational materials that address mental health screening and reducing misperceptions of mental illness. The materials were developed by the APA.

Part of the challenge in the timely identification of mental illness is making the public aware that primary care doctors can diagnose and treat many common mental health conditions, said Kingsport, Tenn., family physician Reid B. Blackwelder, MD.

To raise awareness, physicians should promote in their communities the mental health services they offer by writing editorials in local newspapers or speaking to area media, said Dr. Blackwelder, president-elect of the American Academy of Family Physicians. Doctors need to say that mental health “is an important issue, and these are the resources you have,” he added.

Benefits expanded under ACA

Improvements are expected to be seen in the near future due in part to the Mental Health Parity and Addiction Equity Act of 2008, which requires parity between mental health benefits and physical health benefits.

Additionally, the Affordable Care Act is expected to expand mental health and substance abuse benefits for more than 60 million Americans, according to the Obama administration.

Some doctors are skeptical, however, of the long-term impact either of the laws will have on mental health care.

Part of the problem is a shortage of mental health professionals and the reluctance of many people to visit such specialists due to the stigma surrounding mental illness, said San Diego psychiatrist David M. Reiss, MD.

He said it’s possible that the ACA will make it easier to get short-term care, but good long-term follow-up probably will be limited.

“This leads to a lot of patchwork Band-Aid care,” Dr. Reiss said. “You can put people on medication, but that doesn’t deal with the underlying problem.”