America’s Great Society requires great health
Over 50 years ago, President John F. Kennedy identified mental illness as one of America’s “most critical health problems.” The result was the Community Mental Health Act of 1963, one of the final pieces of legislation he signed before his death that year.
We have made much progress since then. We better understand causes of mental illness, substance use disorders and other behavioral health problems and have scientifically established prevention programs that decrease the likelihood they develop. We have treatments that are more effective and better tolerated and a workforce that is better trained than ever, yet mental illness and substance use disorders remain “critical health problems.”
In 2017, America experienced more than 45,000 deaths due to suicide and another 70,000 deaths due to unintentional drug overdose. Treatment costs were estimated at $380 billion and costs due to missed work and decreased productivity because of behavioral health issues added another $900 billion. Improving behavioral health in America is both compassionate and financially prudent.
To meet the challenge of becoming a society with great behavioral health, we must augment our traditional treatment approaches with increased emphasis on prevention and early intervention. By improving a person’s skills and resiliency to effectively deal with life stresses we reduce the likelihood of mental illness or substance use problems developing. This cannot be restricted to the purview of behavioral health “specialists,” but must be a focus for all of us.
In no area is this more important than with our children. Children who experience abuse, neglect and other adverse experiences are more likely to have tragic life outcomes. They are less likely to graduate from high school, more likely to become pregnant as teenagers, more likely to experience mental illness and addiction, more likely to die from suicide and more likely to die prematurely from cardiac disease and cancer. Preventing child abuse and neglect can help. Additionally, there are specific school-based prevention strategies that lead to higher graduation rates, decrease likelihood of incarceration and lower likelihood of developing a mental illness or substance use disorder, all problems that can be disabling and costly to individuals, families and communities.
For those of all ages who experience behavioral health problems, help must be easily accessible and focus on early identification and intervention. This too, is an area where great progress has been made. Many primary care providers routinely screen for depression and substance use issues and have the skills to intervene promptly and effectively. Behavioral health practitioners are increasingly imbedded in primary care settings to augment services, although this is not yet routine. Unfortunately, access to specialized behavioral health care remains challenging at times due to workforce shortages. Development of the future behavioral health workforce will require approaches that go beyond training of practitioners, and include utilizing creative approaches. such as telemedicine, teletherapy and effective computer-based therapies.
Improving the behavioral health of our society can be accomplished. For maximum impact, commitment and collaboration among all of us is necessary, including parents, communities, educators, faith-based organizations, health care providers and many others. In a society where we seem to have difficulty working together on many things, perhaps we can agree that improving our society’s behavioral health is worthwhile. Our communities, and especially our children, deserve it.
It has been 55 years since JFK laid out his plan for improving behavioral health in America. With application of good science and public determination, we can achieve it.
Mark Hurst, MD, is director of Ohio Department of Mental Health and Addiction Services.