Over 50 years ago, President John F. Kennedy presented a Special Message to Congress identifying 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 in November of that year.
We have made much progress in the past 55 years. We better understand the 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, and responding promptly to those who have experienced it, can put the life course of these children on a better trajectory, and lead to better outcomes for them and for our society. 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. We have done this with other health problems such as cardiac disease. With sustained efforts that began in the 1960s, premature cardiac deaths dropped dramatically due to improved treatment, and effective prevention strategies that included exercise, smoking cessation and healthy diet. The public endorsement and acceptance of this multi-faceted approach, not just the intervention of the medical field, led to this outcome.
Likewise, behavioral health can achieve these dramatic results. 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 resolve that improving our society’s behavioral health is worthwhile and something we can agree on. Our communities, and especially our children, deserve it.
In his inaugural address, President Kennedy laid out a plan to send a man to the moon by the end of the 1960s, and with good science and public determination, it happened. It has been 55 years since he laid out his plan for improving behavioral health in America. With application of good science and public determination, we can achieve that, too.
Mark Hurst, MD, is the director of the Ohio Department of Mental Health and Addiction Services.