World Mental Health Day

Primary health care vs. mental health care.

Mental health care, including addiction, has traditionally run on a separate but very unequal track, compared to primary health care. Of the more than 450 million people around the world who suffer from a mental disorder, it is estimated that fewer than half receive medical help of any kind. Most developed countries have carved out mental health services as a distinct medical institution—one marked by less funding, reduced options, limited services, and little connection to overall health care needs.

Saturday, September 10, marks the 17th annual World Mental Health Day. Established by the World Federation for Mental Health, the day is commemorated through a variety of events and programs in more than 100 countries. The group calls for sustained advocacy on behalf of quality care for people with mental and emotional health problems all over the world.

The campaign theme for 2009 is “Mental Health in Primary Care,” with a focus on worldwide efforts to shift mental health diagnosis into mainstream healthcare. Primary care is the term used to describe the long-term relationship between an individual and their doctor. A person’s general doctor provides for health needs and coordinates additional doctors and services when needed.

The World Federation for Mental Health notes that “neurological disorders starting in the brain were once seen as a separate matter, not needing any physical monitoring—but in recent years there as been greater recognition of the very important link between good mental health and good overall health.”

The report also states that “those with severe and persistent mental illnesses are often twice as likely to have multiple physical health issues.”

Why is this shift a good idea? According to a study released last year by the World Health Organization (WHO) and the World Organization of Family Doctors, this approach has several advantages: “People can access mental health services closer to their homes, thus keeping families together and maintaining their daily activities.... Mental health care delivered in primary care minimize stigma and discrimination, and remove the risk of human rights violations that occur in psychiatric hospitals.”

In addition, according to the study:

--Most people seek help for mental health problems in primary care settings.

--Mental health problems frequently go untreated in the primary care environment.

--People of color, children, and the elderly are the least likely to receive appropriate care for psychiatric disorders.

--Primary care diagnosis of mental health problems reaches people who cannot or will not undergo specialty mental health care.

Graphics Credit: www.unmultimedia.org

addiction drugs

Paul Wellstone’s legacy

House passes Mental Health and Addiction Equity Act.

I live in Minnesota, so it is with great pride that I report that the U.S. House of Representatives recently passed mental health and addiction legislation named after the late U.S. Sen. Paul Wellstone of Minnesota, involving issues that were very close to his heart.

Wellstone, who died in a plane crash in northern Minnesota in 2002, was a two-term Democratic Senator who championed the cause of full medical insurance for the coverage of addiction treatment and mental illness. The Paul Wellstone Mental Health and Addiction Equity Act of 2007, sponsored by Rep. Patrick Kennedy of Rhode Island, passed the U.S. House on a vote of 268-148. The legislation will now be the subject of negotiations with the U.S. Senate, which earlier passed a similar but less stringent bill, sponsored by Rep. Patrick Kennedy’s father, Sen. Ted Kennedy.

Rep. Jim Ramstad of Minnesota, one of the bill’s key backers, and a recovering alcoholic, told Kevin Diaz of the Minneapolis Star Tribune: “This is not just another policy issue. It’s a matter of life and death for millions of Americans.”

The bill would require insurers to cover mental illness and addiction using the same guidelines as any other physical disease or ailment. Health insurance industry spokespeople said the bill goes too far, and would drive up health insurance premiums by mandating additional expensive treatments. The Senate version does not mandate mental health coverage, and offers exemptions for smaller group health plans.

But advocates of the Wellstone Act say that the provisions in the bill are long overdue. “We’re no longer going to allow people to languish in the shadows,” said Rep. Kennedy.

The House and Senate will also have to grapple with how the new bill will effect existing state legislation. According to Victoria Colliver in the San Francisco Chronicle, more than 25 states already have laws on the books mandating mental health coverage. Said California State Assemblyman Jim Beall Jr., who supports the Wellstone Bill: “If you don’t cover moderate mental problems or substance abuse, which often go together… you would not treat the person until their problems become acute—that’s not good health care.”