It is not getting any easier to adequately address the needs of patients with mental illness.  The challenge is exponentially heightened for those in acute need, who turn to community health centers or office based practices, only to be redirected to the ultimate repository for many more these days-- the emergency department.  In fact, the circumstances are getting murkier.  With the addiction epidemic remaining at full throttle, more patients are in need of timely resources suited to help on more than one front as the two frequently go hand in hand. 

With fewer options to substantively help with either, the overwhelming conditions have not helped to reduce the stigmata attached to patients with mental illness and/or addiction. Last week two more patients who had been in and out of local emergency departments in the past few weeks for addiction and underlying mental illness died.  Both of these people were able to recognize how serious their problems had become, how impossible it was for them to get help, how they had been pushed out of jobs by employers based on their mental illness and had no readily accessible resources to get psychotropic meds or other treatment, only to continue self-medication.  They left grief-stricken family members, friends and children who will never know their parents from then on.  Opinions follow, with it not being uncommon for them to be laden with harsh and unwarranted judgments regarding mental illness, the entangled complicating factors of addiction and conjecture of which comes first, the proverbial chicken and egg theory.

“Those who are mentally ill are more likely to abuse drugs. The two issues often go hand in hand. According to SAMHSA [Substance Abuse and Mental Health Services Admin.], 26.7 percent of people with mental health issues abused illicit drugs in 2012. In the general public, only 13.2 percent of people abused drugs. Per the National Institute on Drug Abuse (NIDA), those who suffer from mental illness may attempt to self-medicate their symptoms via drug use.”  Drug Abuse.Com, Credit: Robert Weathers, PhD – CalSouthern PsychologyNot recognizing how one may get stuck to a bias or possibly a more deeply rooted aversion preventing the same level of compassion and necessary consideration offered to those with other conditions from being offered to those with mental illness only makes the gorilla in the room bigger.

A recent discussion with a reunited childhood friend, who, serendipitously, works with a public relations firm, peaked my interest with the description of an initiative by some key administrators regarding the stigma of mental illness in the workforce and population at large.  The National Alliance for Mental Illness (NAMI) in Massachusetts has been awarded a grant from the attorney general to support the "CEOs Against Stigma" campaign.  The campaign goal “is to increase the knowledge, comfort and ability in recognizing and managing issues related to mental health in the workplace. Changing the way we think about mental health in the workplace is a necessary part of this process. This shift in thinking is best achieved through accommodation, support, training and education.” NAMI Mass’ CEOs Against Stigma Campaign The Role of Affiliates, 3/27/15“Collectively these kinds of approaches do not require spending much more money than is being spent today on individuals with challenging conditions.  More than one study has demonstrated, for example, that the government spends on homeless individuals with mental illness--including emergency department, hospital, police and court costs--the equivalent of what the mental health system would need to fund and subsidize an apartment and provide necessary on-site services.  Other studies document the cost savings from supported employment.”  The Promise of the Americans With Disabilities Act for People With Mental Illness, Ira Burnim, JD, JAMA, Vol. 313 #22 p.2223-2224, June 9, 2015

Now is the time to be extremely mindful and purposeful in addressing the need to bolster and develop community services for our patients, colleagues and family members with mental illness.  Approximately 61.5 million Americans experience mental illness a year.  Twenty percent of 13-18 years old have a severe mental illness disorder in a given year and 13% of those 8-15 years old. NAMI Mental Illness Facts and Numbers, March 2013

Failure continues to be directly linked to a lack of public health awareness and investment in preventative measures.  Some of this is, of course, due to very limited budgets to redirect funding.  However, the larger obstacles are linked to a reluctance to focus on early intervention and prevention.  There might be more willingness to invest intellectual capital to develop public health prevention if there was more shared insight in our health care organizations and communities about the intricacies of mental illness. 

Many people are not aware and are fearful of getting too close to the issues even when it concerns their children or partners.  It only makes sense that others with less intimacies to those with mental illness would do anything other than try to get further away.

As health care providers we remain as not only clinical content experts but those who can facilitate critically huge changes for the public health of our civilization.


Lukas Kolm, MD, MPH

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