NEWS

"Transformation" prescribed for mental health care in the USA

Desmond Avery

Bulletin

Mental illnesses are "shockingly common" in the USA, the New Freedom Commission on Mental Health recently reported to President Bush, and they "affect almost every American family." In any given year, 5–7% of all American adults have a serious mental illness, and 5–9% of all children have a serious emotional disturbance, the report says. It calculates that these illnesses cost the economy US$ 79 billion a year in lost productivity, and a further US$ 71 billion is spent each year on treating mental illness, out of a total of over US$ 1 trillion spent overall on health care in the USA.

Despite these giant problems, the Commission produced an optimistic report, entitled Achieving the promise: transforming mental health care in America, released on 22 July. It had been charged by President Bush in April 2002 to make recommendations that would enable everyone with mental disorders "to live, work, learn and participate fully in their communities". Its recommendations emphasize recovery and resilience and are organized as six goals, concerned with promoting public understanding, consumer choice, equality, early screening and referral, research, and information technology. The current system, the report says, needs not just reform but transformation.

Fuller Torrey, a psychiatrist specializing in schizophrenia and manic depressive illness and president of the Treatment Action Center in Arlington, Virginia, commented: "Although the Commission’s focus on recovery is understandable and recovery for all is a laudable long-term vision, it is important to remember that recovery is not currently possible for every person who has a severe psychiatric illness."

Other reactions were more enthusiastic. Norman B. Anderson, head of the American Psychological Association, applauded the report and said, "When implemented, these recommendations will help to ameliorate the fragmentation that is rampant throughout our country’s existing mental health delivery system and will significantly improve the lives of people living with mental disorders."

Bedirhan Üstün, who coordinates WHO’s work on the classification of disabilities, told the Bulletin: "The report emphasizes the immense burden of mental disorders which are the number one cause of disability worldwide, and rightly deplores the unfair limitations placed on treatment options and insurance coverage for mental health."