Healthy People 2010—Conference Edition

Chapter 18 Mental Health and Mental Disorders

Trends

Research on the brain and behavior in mental illness and mental health is moving at a rapid pace. An increasingly strong consumers’ movement in the mental health field is adding urgency to the tasks of translating new knowledge into clinical practices and refining service delivery systems to use new and emerging information optimally for patient/consumer needs. Consumer and family organizations, which formed out of concern over frequent fragmentation of mental health services and lack of accessibility to such services, have assumed a substantial role in supporting development of mental health services. Diverse groups share overlapping goals, including overcoming stigma and preventing discrimination toward persons with mental illness, promoting self-help groups, and promoting recovery from mental illness.¹⁸

The co-occurrence of addictive disorders among persons with mental disorders is gaining increasing attention from mental health professionals. Among adults aged 18 years and older with a lifetime history of any mental disorder, 29 percent have a history of an addictive disorder; of those with an alcohol disorder, 37 percent have had a mental disorder; and among those with other drug disorders, 53 percent have had a mental disorder.¹⁷ Having both mental and addictive disorders within the same year is a particularly significant clinical treatment issue, complicating treatment for each disorder. About 3 percent of the population aged 18 years and older has been identified as having co-occurring mental and addictive disorders in 1 year.^{3, 14} Of those with a serious mental illness, 15 percent have both types of disorder in one year, and of those with a severe and persistent mental illness, 27 percent have both mental and addictive disorders.¹⁴ Co-occurring, or comorbid, mental and addictive disorders are estimated to affect 50 to 60 percent of homeless persons.²⁰ Comorbid mental and addictive disorders also are evident in children and adolescents.²¹ Especially at risk for alcohol use problems are boys diagnosed with so-called externalizing disorders such as conduct problems, oppositional-defiant disorder, and attention deficit/hyperactivity disorder (ADHD).²² From public health promotion and disease prevention perspectives, it is noteworthy that children and adolescents with mental illnesses often do not become substance abusers until after the mental illness becomes apparent.²³ This time lag creates a window of opportunity when prevention of substance abuse in these children may be possible.²¹

As the life expectancy of Americans continues to grow longer, the sheer number—although not necessarily the proportion—of persons experiencing mental disorders of late life will expand. This trend will present society with unprecedented challenges in organizing, financing, and delivering effective preventive and treatment services for mental health in this population. As recognition continues to grow that depression and certain cognitive losses are treatable disorders and not inevitable concomitants of aging, diagnostic precision in later life and provision of targeted treatment are increasingly urgent.

Health care in the U.S. continues to undergo fundamental structural changes that require creative and flexible responses from service providers, administrators, researchers, and policymakers alike. Two prominent forces of change are Federal and State efforts to improve access to health care, including mental health care, and the rapid growth and impact of managed care. In 1998, the Mental Health Parity Act (P.L. 104-204) was implemented to help increase access to care. Although the Federal Mental Health Parity Act is quite limited in reducing insurance coverage discrepancies between physical and mental disorders, 53 percent of the U.S. population is now covered by State mental health parity laws. The term “parity” or “mental health parity” refers generally to insurance coverage for mental health services that includes the same benefits and restrictions as coverage for other health services.

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