Mrs. Carter says the stigma of mental illness still prevents Americans from seeking help.

By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

May 22, 2002 - When America faced some of its darkest hours, former first lady Rosalynn Carter provided reassurance and hope. And for over three decades now, Carter has provided solace to those engaged in a less visible national tragedy - mental illness.

"Back in 1967, nobody would talk about it," says Carter. "Nobody was interested. No politician would mention it. Mental health just got what was left over after everything else - all the health programs - was funded. I saw the situation of how much the people who suffered from mental illnesses needed help. I've been working on it ever since." Tirelessly.

As first lady, Carter served as the honorary chair of the President's Commission on Mental Health that ultimately spearheaded the passage of the 1980 Mental Health Systems Act which dramatically increased funding for mental illnesses.

And Carter's advocacy remained undiminished after her husband left office. Together they established The Carter Center, and later the first lady created the Center's Mental Health Program. Two years ago, The Carter Center hosted the Inaugural World Conference for the Promotion of Mental Health.

"We invited everybody that had worked on preventing mental illness and the promotion of mental health," says Carter. "It was very exciting and there are some good things going on if we could just get the funding to support the research. I think the time is coming when we could do that."

And perhaps not a moment too soon. To help promote better understanding of mental illness, May has been designated Mental Health Awareness month.

National crisis

Tens of millions of Americans suffer from some form of mental illness. According to the Surgeon General's report on mental health:

One in five Americans at some point during the year will have a mental disorder.

15% of adults will use some form of mental health service during the year.

Depression is the second-most disabling illness in the developed world.

According to 1996 estimates, mental illness directly and indirectly costs the US economy 148 billion dollars.

But while approximately 54 million Americans will experience mental illness, only eight million will actually seek treatment.

"It's a combination of reasons, but I think the major factor is stigma," explains Carter. "It goes back to the time when we didn't know anything about the brain and nobody knew how to treat people with mental illness. We kept them sedated and out of sight."

Carter points out that historically society viewed a person with mental illness as having a character flaw or something wrong with them that wasn't biologically based.

"Now we know that's not true," notes Carter. "I think all illnesses are biological and can be treated. They might have to take medicine all their lives like people with high blood pressure or diabetes."

"Still, the stigma is devastating," adds Carter. "A woman in church recently told me that she was suffering from depression and her family didn't want her to go for help. She said, 'They told me I can pull myself up by my boot straps if I want to.' That kind of idea comes from a fundamental lack of understanding about the disease." And that gap in comprehension can often mean the difference between life and death.

Depression era

While anxiety disorders are two times more prevalent than other mental illnesses, most clinicians agree that depression is the most alarming. "Depression is extremely serious not only in terms of the cost but most importantly because of the potential for suicide," says Dr. Gregory Fricchione, Director of the Mental Health Program at The Carter Center. "By 2020 the World Health Organization estimates depression will be the second-most disabling illness in the world, surpassed only by cardiovascular disease." Nearly 19 million Americans experience clinical depression - with women suffering almost twice the rate of men. But many doctors maintain these figures may be inaccurate because our society discourages men from reporting their bouts with depression.

There are upwards of 30,000 suicides each year in the US, making suicide the third leading cause of death for young people from 15 to 24. Around 35% of all deaths by suicide are caused by depression.

Recent research shows that medications such as selective serotonin reuptake inhibitors (SSRIs) are an effective treatment for both moderate and clinical depression. Older tricyclic medications caused significant side effects including cardiac toxicity. SSRIs, like Prozac, Paxil and Zoloft, are safer for the heart with only minor side effects such as gastrointestinal distress, restlessness, and reduction in libido. "After the first episode of depression patients should be kept on SSRIs for one year after returning to baseline before tapering off," states Fricchione. "After a second episode the chance of experiencing a third bout of depression increases 50%. And after a third episode the likelihood of a fourth recurrence is 90%. Recognizing these recurrence rates, patients should at times be counseled to stay on their medication."

While SSRIs are effective, experts maintain that the combination of medication and psychotherapy together are the most effective method of treating depression, particularly in helping patients maintain long-term mental health.

Equal rights

Despite her best efforts, Carter is still concerned that the issue of mental health is too often ignored. "We've never gotten in the mental health area the kind of funding that was needed," states Carter. "When Jimmy was president, we increased the research tremendously. But it was not funded as much as we would have liked. That's why, because of funding, we are where we are today with these illnesses."

Funding is often scarce not only for research but also for proven, effective treatments - even when people have insurance. Nearly all health plans differentiate between physical illness and mental illness, with coverage for the latter sometimes as little as 25%. Yet many physical ailments that are covered 100% are actually caused by mental illnesses.

"It's so ridiculous to me," says Carter. "We have found that with large companies that provide total care for their employees, that over a period of time the total health costs come down, because people don't go to the doctor so much for stomachaches or headaches, or feeling bad." "It is called parity legislation, and it is something that Mrs. Carter has been advocating for many years," says Fricchione. "Implementing parity results in negligible cost increases of about one percent. A lot of money is spent in primary care trying to rule out medical causes for what are really psychiatric disorders."

Fricchione also recommends helping primary care physicians better recognize mental illness to provide first line treatment. The U.S. Preventive Services Task Force recently estimated that over half the patients with depression are missed or under treated by primary care physicians. The panel recommended that all patients visiting primary care physicians for any reason be asked two questions designed to help reveal depression, estimating that this simple effort would identify 90% of patients with depression.

"Many people are simply not comfortable seeking treatment for mental illness but instead go to their family doctor," explains Fricchione. "Clearly people are still dealing with a high degree of stigma when it comes to mental health issues." "But I see some hopeful signs," adds Fricchione. "A recent study indicated that more people are getting treatment for depression. So we're seeing some progress that people are viewing depression as a treatable illness."

"We've learned so much about the brain in the last few years," says Carter. "Everything has changed since I became involved, and I have been working on it for over 30 years now. Still many people don't know that mental illnesses can be diagnosed, treated and the overwhelming majority of people can lead normal lives."

To learn more about mental illness and The Carter Center's efforts to promote mental health, please join Mrs. Carter this Friday at 4PM ET for an on-line chat.

Click here for more information about mental health.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 12/13/2003  -  Donnica Moore, M.D.