Mental Health 101
What is Mental Health?
Almost sixty years ago, the World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition opened the window to an increased recognition of the human as a holistic being of mind, body and spirit, and propelled the need to better understand the interrelationship between physical and mental health.
Mental health is how a person thinks, feels, and acts when faced with life's situations. It is how people look at themselves, their lives, and the other people in their lives, evaluate their challenges and problems, and explore choices. This includes handling stress, relating to other people, and making decisions.
The HHS Substance Abuse and Mental Health Administration’s (SAMHSA) vision is “a life in the community for everyone.” Their mission is to build resilience and facilitate recovery in the areas of substance abuse and mental illness.
Mental Health Problems (Also known as Mental Disorders and/or Mental Illness).
Mental health problems are real. They affect one's thoughts, body, feelings, and behavior. Mental health problems are not just a passing phase. They can be severe, seriously interfere with a person's life, and even cause a person to become disabled.
Mental disorders constitute an immense burden on the U.S. population, with major depression now the leading cause of disability in the U.S., and schizophrenia, bipolar disorder (manic depressive disorder), and obsessive compulsive disorder ranked among the ten leading causes of disability. One person in four has been diagnosed with a mental disorder in the last 12 months and is consequently in need of services.
These disorders cause distress and result in a reduced ability to function psychologically, socially, occupationally, or interpersonally. People who have a mental illness might have trouble handling such things as daily activities, family responsibilities, relationships, or work and school responsibilities. You can have trouble with one area or all of them, to a greater or lesser degree. And you can have more than one type of mental illness at the same time.
What Are Risk and Protective Factors?
Risk factors increase the vulnerability of an individual, a group, or a community to substance abuse disorders or untreated mental health problems. Biology and heredity are among those risk factors for mental disorders; for example, children of parents with depression or schizophrenia are at greater risk for the disease, possibly due to a genetic predisposition. Similarly, the greater the number of drug abuse risk factors, the greater the risk for drug abuse. Additional risk factors might include a history of violence and or trauma, poverty, school problems, out of home placement, depression, and or suicide attempts. Although no one risk factor is disorder specific, multiple risk factors are often related to more negative outcomes such as mental disorders.
Protective factors build resiliency in the same individual, group, or community and increase the likelihood that substance abuse and its related effects can be resisted. These may include a positive self-esteem, an outgoing personality, supportive family relationships, and strong bonds to family, school and community. Multiple protective factors improve one's chances for positive outcomes.
Resilience is a set of strengths internal to the individual and is highly influenced by protective factors. Resilient people are those who are better able to resist destructive behaviors, even in the presence of identified risk factors.
Minority populations are often over represented in our nation’s most vulnerable populations, the poor, the uninsured, the homeless, and the incarcerated; they have little access and/or may under underutilize mental health services. For those who do receive mental health interventions, the appropriateness and quality of those treatments remain in question. These unmet needs and provision of poor quality mental health services to minority populations is impacting the well being of our nation.
Disparities in Mental Health
The United States population is composed of many diverse groups. Evidence indicates a persistent disparity in the health status of racial and ethnic minority populations, as compared with the overall health status of the U.S. population.
Over the next decade, the U.S. will continue to become more racially and ethnically diverse, increasing the demand for mental health services tailored to community needs. This will have significant consequences for the need and demand for providers of mental health services. Poverty, lack of adequate access to quality health services, few culturally and linguistically competent health providers and services, and lack of preventive health care are all factors that must be addressed.
A key finding of the Surgeon General’s Report on Mental Health: Culture, Race and Ethnicity (2001) was that living in poverty has the most measurable effects on the rates of mental illness. Racial and ethnic minorities are overrepresented among the poor. People in the lowest socioeconomic positions are at least 2-3 times more likely than those in the highest positions to experience a mental disorder, and the overall rate of poverty among most racial and ethnic minority groups in the U.S. is much higher, than that of non-Hispanic Whites. Racism and discrimination are highly stressful and can adversely affect health and mental health.
With advances in research, the causes and treatments for mental illness are better known today than ever before. According to recent reports, the great majority of mental illnesses are treatable. Some have found that 80 percent of patients with depression can now recover (National Institute of Mental Health, 2004). With treatment and recovery more reachable, everyone regardless of age, sex, religion, race, ethnicity, primary language or national origin should have the right and access to evidenced-based mental health services.
Although mental illnesses are surprisingly common, affecting up to 28 percent of our nation, recovery is possible. Studies show that many people with mental illnesses recover completely (SAMHSA, 2003). With treatments and supports available now more than ever, people with mental illnesses can lead active, productive lives and contribute to their communities.
Yet stigma continues to be a major barrier to seeking out care. Many people are still confused between facts and myths. They don’t understand what mental illnesses are and continue to believe that there is something shameful about them. In addition to shame, minorities often feel the legacy of racism and discrimination, leading to the distrust of health and mental health professionals. Feelings of stigma, discrimination, and mistrust of authorities preclude individuals in need from seeking out and receiving the help and treatments that can lead them to recovery.
Because the small numbers of minorities that do seek behavioral health care prefer seeking and receiving that care in primary care settings, it is in our best interest to nurture and further develop this entry point into treatment, and we must assure the presence of a sensitive workforce that is culturally and linguistically competent. As such, providers themselves will help to break down some of the barriers created by stigma, while providing needed care.
Mental Health Treatment
Treatment for mental health depends on the specific condition or combination of conditions, and should rely on evidence-based practices. These treatments have been studied and proven effective in reducing symptoms and promoting wellness.
Research has contributed to our ability to recognize, diagnose, and treat mental health conditions effectively in terms of symptom control and behavior management. Medication and other therapies can be independent, combined, or sequenced depending on the individual’s diagnosis and personal preference. A new recovery perspective is supported by evidence on rehabilitation and treatment as well as by the personal experiences of consumers.
Substance abuse is a major co-occurring problem for adults with mental disorders. Evidence supports combined treatment, although there are substantial gaps between what research recommends and what typically is available in communities.
Although sensitivity to culture, race, gender, disability, poverty, and the need for consumer involvement are important considerations for care and treatment, barriers of access exist in the organization and financing of mental health services for adults.
Because of the lack of access to preventive care, early identification of mental illness and lack of quality interventions, the service needs of minorities may exceed those of Whites. Poverty and lack of (or insufficient) medical insurance hampers access to care, often leading to more chronic mental health conditions. High concentrations of poverty in inner cities and the combination of isolation and poverty in rural and frontier areas pose additional challenges for residents of these areas.
In a recent report titled: “Health Centers’ Role in Answering the Behavioral Health Needs of the Medically Underserved” (2004), the Health Resources and Services Administration (HRSA) reported that community health centers (CHC) are the primary care providers to 15 million medically underserved individuals. They have become critical sources of behavioral health services to those most vulnerable, particularly minority populations, the poor and the uninsured. According to the 2003 CHC Uniform Data System, health centers reported 2.1 million encounters for mental health conditions and 720,000 contacts for drug or alcohol dependence.
The Indian Health Service (IHS) is an integrated health care system that provides valuable mental health services to American Indians and Alaska Natives (AI/AN) through its Mental Health and Social Services program. This program is community oriented, clinical and preventive — providing care to more than 1.6 million consumers, both urban and reservation-based. Nevertheless, the accessibility of mental health and substance abuse treatments continue to be a problem. Proven and Carle (2000) found the greatest unmet needs for adult AI/ANs to include substance abuse and mental health out-patient counseling services.
For more information about Mental Health:
SAMHSA, Center for Mental Health Services
National Institute for Mental Health (NIMH), NIH
American Psychological Association
American Psychiatric Association
National Alliance for Mental Illness
National Mental Health Association