This issue of Mental Health News explores the interrelationship between physical and mental health. For treatment professionals and service providers, this theme brings forth the knowledge that people with mental illness suffer from the ills of poor physical health to a much greater degree than the general population. Many of the articles in this issue address this troubling health crisis. As a consumer myself, I share this concern and have been affected by it since I became ill with depression in 1989. Before I comment on that aspect of our theme, I can’t help but touch upon the mental health repercussions of the current economic crisis.
The Current Economic Crisis and The Nation’s Mental Health
As people in communities throughout our nation are feeling the extreme pinch of the economy, I find myself pausing to reflect upon the troubling mental health repercussions this is having on them. Here are just a few examples from recent evening news reports.
In one piece on the crisis in housing foreclosures, a well-dressed, educated, middle aged woman in Florida was sitting in her kitchen with fear written across her face. “I might be homeless in a few weeks,” she replied, “Nobody seems to be able to help me, and I don’t really think that anyone cares.”
Another piece reported on a woman from New York who managed the family’s finances and had not told her husband how badly they had fallen behind in their mortgage payments. Without warning and with the knowledge that their home was about to go into foreclosure, she called their mortgage company to tell them that she had no other choice but to kill herself so that her family could collect on the insurance and keep their home. Soon after her call, the mortgage company called police to report her disturbing call. By the time police arrived, she had already taken her own life.
How sad and so real this story seemed to me. I know from my own experience with mental illness that there is nothing worse than feeling you will be unable to financially support yourself and your family, or that you will lose your home and have no place to live. The cost of feeding oneself (not to mention a family of three or four kids) has reached record highs, and thousands of people every day are being laid off from their jobs or losing their businesses across all levels of employment. This has surely lead to increased feelings of fear, stress, and loss for many. These negative emotions act as triggers and can cause decay in both realms of our physical and mental health. A clear example of the cost of fear and stress can be seen in soldiers returning from Iraq and Afghanistan suffering from Posttraumatic Stress Disorders (PTSD). Unfortunately, we are likely to see a similar increase in cases of depression and suicide in people across the nation during these difficult economic times.
Cause and Effect
Economists analyze how the stock market responds to global fluctuations in the price of oil and how they are causing the price of bread and milk at the grocery store to rise. Similarly, treatment professionals and mental health service providers understand how people’s emotional state respond to traumatic events in their lives. When someone loses their home or their job this cause and effect situation triggers ripple effects in people’s physical and mental health. Some people will react with stomach upset and headaches while others will fall into depression.
As these ripple effects continue, we are now seeing other vital components of state budgets in crisis due to serious declines in revenues. Governors in many states are now calling for departments in all sectors to cut budgets. These dire situations are continuing to appear and are not likely to go away quietly. Talk and worry abounds within the mental health treatment and services community that already thin operational budgets will be cut even more and that many programs throughout the nation will suffer or have to be closed altogether. This does not bode well for individuals and families struggling with existing mental health problems, and for the ever-increasing ranks of people that will be in need of mental health care who are victims of the current economic crisis.
Because each of us has different levels of physical and psychological strengths, understanding how and why people may or may not react to the fear and stress brought on by traumatic external events can be difficult.
If you think of it as a delicate tower of blocks that little children have so much fun building, our mind and bodies make up our own delicate and critical infrastructure. When one part of this structure begins to weaken, it can affect the other parts as well. As resilience to crisis varies tremendously from one person to another, the stress that triggers one person’s headache or stomach upset may cause someone else to spiral into a deep depression. Many scientists believe it all comes down to genetics and body chemistry. We now understand that imbalances of serotonin in our brains are responsible for the onset of many forms of mental illness. These recent advances in our understanding of mental illness are leading to more efficacious and targeted medications used to treat mental illness. This is a plus for those who suffer and continues to lead us to understand that mental illness is a medical disease that can be treated.
Certainly, the tragic news reports I mentioned previously are troubling and should cause us to be more sensitive and vigilant to people going through tough economic times. As more and more people lose their homes, jobs, and fall closer to economic poverty, the mental health repercussions will surely continue to rise. Will we be able to meet their needs and provide the mental health services needed to help them survive?
The Decline in Physical Health for People with Serious Mental Illness
On the other side of this issues’ theme, the recent “Morbidity and Mortality in People with Serious Mental Illness” report published in 2006 by the National Association of State Mental Health Program Directors (NASMHPD), revealed a serious decline in the physical health of people with serious mental illness (SMI) across the United States. This report found that people with SMI are dying 25 years earlier than the general population. This alarming report determined that people with SMI are falling victim to modifiable risk factors such as smoking, obesity, substance abuse, and inadequate access to medical care.
As someone who survived a serious mental illness, I learned many things along the way. It is alarming to me when I think back on those years to the things I experienced personally and what I was able to witness firsthand within the ranks of my fellow consumers in treatment.
Before I fell ill to depression in my late 30’s, I was in relatively good health. I was a smoker, but not to the compulsive degree that did develop during the darkest days of my 10-year ordeal. I was much thinner, did not have cardio-pulmonary disease, and did not suffer from rapidly declining dental health that caused me to lose many of my teeth.
As a consumer, I participated in years of day-treatment programs and inpatient stays in the hospital. I didn’t pay much attention to it at the time, but looking back, I can recall that my fellow consumers and I were all smoking way too much, were not eating healthy foods, and we were certainly not involved in any regular exercise programs. Overweight and chain-smoking patients were the norm and what you would see when you were in these programs. Our psychiatric illnesses prevented most of us from working and earning a decent living. Because of this, most consumers only had a few dollars a week from entitlement programs such as SSI, SSDI, Medicaid, and Medicare. What resources we did have that wasn’t going to rent (even if you were in supportive housing), utilities and transportation, was spent on buying inexpensive and easy to prepare meals and cigarettes. In addition, few of us had good medical insurance plans and were continually short changed when it came to sufficient or preventive care. For example, few could afford or had insurance that covered dental health care. When a tooth became problematic, your only option was to have it pulled rather than having a more expensive reconstructive or cosmetic procedure. Losing your teeth this way is very humiliating to consumers and certainly adds to your already low self-esteem. These are all things that were brought out in the NASMHPD report.
One of the most important results of the NASMHPD report is that it has sounded a call to action in the mental health community. In this issue, we read about several promising programs that hope to assist consumers in controlling diabetes, or preventing it in the first place, by exercising, choosing a healthier diet and quitting smoking. These programs are beginning to sprout up in day-treatment programs and are also following consumers in residential settings. I think this a good start but needs to become a universal mind-set in mental health communities across the country.
Improving the assessment and treatment of SMI at the primary care level is becoming increasingly important. In addition, our inability to successfully house people with co-occurring serious mental and physical disorders has caused many to end up in nursing homes. More needs to be done to enable people to live in the community, and to improve access to medical and dental care. By increasing the levels of healthcare coverage now being provided to people with SMI, consumers who rely on government entitlement for their healthcare will have a better chance at fending off diabetes and cardiovascular disease and live healthier and longer lives.
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Good Luck in Your Recovery!