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This op-ed was originally published in the May 29, 2004, edition of The Washington Post.


By Thomas H. Bornemann

At a time when the United States leads the world in almost every measurable category, and when its defense budget is greater by far than that of any other nation, it's sad to note that there is one major area in which we continue to lag behind other industrialized nations: the provision of health care to our people -- especially care for people with mental illnesses.

Last summer a presidential commission on the subject declared in its final report that the American mental health system is "fragmented and in disarray . . . leading to a host of problems including disability, homelessness, school failure and incarceration." Nearly a year later, as Mental Health Month draws to a close, little has changed. Many people with mental illnesses lack access to affordable, adequate services or avoid treatment because of the stigma associated with their illness.

From the work of the commission -- as well as from the 1999 surgeon general's report on mental health and a 2001 World Health Organization report -- we know a great deal about the magnitude and burden of mental illness. We know that when suicide is included, mental illness accounts for more than 15 percent of the burden of disease in industrialized countries -- more than the burden inflicted by all cancers. We know that almost 34 million Americans -- 21 percent of people between the ages 18 and 64 -- will have a mental illness over the course of a given year. We know that nearly 70 percent of people suffering from mental illness are not getting the help they should, and that 79 percent of U.S. children with mental health problems severe enough to indicate a clinical need for evaluation do not receive either evaluation or treatment.

Too often, when symptoms reach the point of crisis, which many will, the most expensive services are required through emergency rooms and inpatient treatment. In many cases, jails and detention centers have become the front-line providers of mental health services, causing a much greater financial burden than if prevention and community-based resources were readily available and affordable to everyone.

The burden of mental illness goes beyond the fragmented service system and into the business sector.

It is in the interest of corporations to provide adequate mental health coverage as part of their employee benefits. Research shows that untreated depression costs firms $31 billion a year in lost productivity.

Today more is known about the causes of mental illness than ever before, and through groundbreaking research we finally can provide treatments that work. About 80 percent of patients with depression can recover now, and 74 percent of patients with schizophrenia can live without relapses if early intervention is made. Recovery is possible.

A presidential commission on mental health during the Carter administration focused on developing a network of community-based services and supports. In many ways, the challenges that were present 25 years ago remain, despite remarkable scientific advances since then. And be assured, the advances are real. When I was trained in the early 1970s, we never envisioned that recovery was possible. Now it is often expected.

One would think this progress would bring about a drastic change for the better in the provision of mental health services. But since the latest commission reported last summer, mental health services have been cut in almost every state, and the prospect of more restrictions looms. The reductions have been so massive that in some cases people with serious mental illnesses have gone without even the most basic services.

In addition, a bill to require full mental health parity for insurance has failed to move in Congress in the two years since President Bush expressed his support for the legislation. Parity would not only make mental health services affordable for the great majority of Americans, it would recognize that mental illnesses are treatable and as common as other medical conditions.

Until legislation acknowledges and legitimizes mental health parity, and policymakers provide adequate resources for treatment and support services, mental illnesses will remain stigmatized, and people will be reluctant to seek treatment. Suicides will continue to be the greatest cause of violent deaths -- more than homicide or war-related deaths -- and expensive emergency services will be the primary source of treatment for many.

Mental illness affects everyone, be it through a family member, friend or personal experience. We all need a transformed mental health system that envisions recovery for everyone suffering from mental illness.

The writer is director of the Mental Health Program at the Carter Center in Atlanta.

© 2004 The Washington Post Company