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Healthy People 2010—Conference Edition

Chapter 18 Mental Health and Mental Disorders

Healthy People 2010 Objectives

Mental Health Status Improvement

18-1.Reduce the suicide rate.

Target: 6.0 suicide deaths per 100,000 population.

Baseline: 10.8 suicide deaths per 100,000 population in 1998 (preliminary data; age adjusted to the year 2000 standard population).

Target setting method: Better than the best.

Data source: National Vital Statistics System (NVSS), CDC, NCHS.

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

*New data for population groups will be added when available.

18-2.Reduce the rate of suicide attempts by adolescents.

Target: 12-month average of 1 percent.

Baseline: 12-month average of 2.6 percent among adolescents in grades 9 through 12 in 1997.

Target setting method: Better than the best.

Data source: Youth Risk Behavior Survey (YRBS), CDC, NCCDPHP.

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.

Suicide is a complex behavior that can be prevented in many cases by early recognition and treatment of mental disorders. It was the ninth leading cause of death in the U.S. in 1996 and the third leading killer of young persons between the ages of 15 and 24.^{47, 48, 49, 50} At least 90 percent of all people who kill themselves have a mental or substance abuse disorder, or a combination of disorders. However, most persons with a mental or substance abuse disorder do not kill themselves, thus other factors contribute to suicide risk. In addition to mental and substance abuse disorders, risk factors include prior suicide attempt, stressful life events, and access to lethal suicide methods. Suicide is difficult to predict; therefore, preventive interventions focus on risk factors. Thus, reduction in access to lethal methods and recognition and treatment of mental and substance abuse disorders are among the most promising approaches to suicide prevention. More targeted approaches should consider risk factors most salient and appropriate for select populations.

18-3. Reduce the proportion of homeless adults who have serious mental illness (SMI).

Target: 19 percent.

Baseline: 25 percent of homeless adults aged 18 years and older had SMI in 1996.

Target setting method: 24 percent improvement.

Data source: Projects for Assistance in Transition from Homelessness (PATH) Annual Application, SAMHSA, CMHS.

Data for population groups currently are not qcollected.

Approximately one-quarter of homeless persons in the United States have a serious mental illness (SMI).⁵¹ New approaches developed over the past 10 years provide ways to lower the number of persons who are homeless who also have SMI. Using persistent patient outreach and engagement strategies, service providers are helping homeless persons with SMI connect with mainstream treatment systems.^{52, 53}

Treatment alone, however, is not enough. Once permanent housing is located, appropriate mental health and social supports can help persons with mental illness remain off the street. Much of this support occurs in the form of case management, particularly if it is responsive both to emerging mental health issues and to the skills a person needs to function and thrive in the community.

18-4.Increase the proportion of persons with serious mental illnesses who are employed.

Target: 51 percent.

Baseline: 42 percent of persons aged 18 years and older with serious mental illnesses were employed in 1994.

Target setting method: 21 percent improvement.

Data source: National Health Interview Survey (NHIS), CDC, NCHS.

Data for population groups currently are not analyzed.

Rehabilitation is an essential part of care for adults with severe mental illness. To promote independent living, rehabilitation programs often evaluate and place these persons in jobs. Rehabilitation programs also provide continuing support and help ensure that the placement is working well. Research shows that working provides both economic and personal benefits for persons with SMI that extend beyond a paycheck and workplace companionship.⁵⁴ Employment also improves self-esteem and independence; it helps a person to manage his or her own illness and return to community life.^{55, 56} A majority of persons with SMI want to be employed and rank employment as a primary personal goal.⁵⁷ Helping persons with mental illness secure employment can reduce the use of mental health services and reduce the number of persons who receive Federal and State disability payments.⁵⁷

18-5. (Developmental) Reduce the relapse rates for persons with eating disorders including anorexia nervosa and bulimia nervosa.

Potential data source: Prospective studies of patients with anorexia or bulimia nervosa, NIH, NIMH.

Anorexia nervosa is the most severe eating disorder, characterized by extreme and often life-threatening⁵⁸ weight loss associated with a distorted body image and a pathological fear of gaining weight. In cases of severe weight loss, hospital treatment often is needed. Studies suggest that from 30 to 50 percent of patients treated successfully in the hospital become ill again within 1 year of leaving the hospital.^{59, 60} Efforts are underway to develop and test specific interventions that can prevent relapse in these patients. For instance, a particular kind of psychotherapy—called cognitive-behavioral treatment—has been found to lower relapse rates in persons with anorexia nervosa.⁶¹ Treatments using medications also have been tried, both alone and in combination with “talking” therapy (unpublished data). Preliminary reports suggest that it might be possible to decrease the chance of relapse, resulting in better long-term prospects for persons with severe anorexia nervosa.

Bulimia nervosa is an eating disorder that involves eating a lot of food (binge eating) and then eliminating it (purging), whether through self-induced vomiting or through the use of diuretics or other medications. Effective short-term treatments exist for this serious mental health problem. When “remission” is defined as being symptom-free of binge eating and purging for at least 4 weeks, about 25 percent of those in remission had a relapse in less than 3 months. Around 9 months after remission, fewer than half (49 percent) of the persons remained symptom-free.⁶² Risk for relapse seems to drop after 4 years of being symptom free.⁶³

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