Section 7. Mental Health Disorders

Chapter 98. Overview of Mental Health Care

Topics: Introduction | Mental Illness in Society | Classification and Diagnosis of Mental Illness | Treatment of Mental Illness

Mental Illness in Society

About 20% of adults will experience a mental illness at some point in their lives. In fact, 4 of the 10 leading causes of disability among people aged 5 and older are mental health disorders, with depression being the number one cause of all illnesses that cause disability. Unfortunately, despite this high prevalence of mental illness, only about half of people who have a mental illness seek professional help.

Although tremendous advances have been made in the understanding and treatment of mental illnesses, the stigma surrounding them persists. For example, people with mental illness may be blamed for their illness or viewed as lazy or irresponsible. Mental illness may be seen as less real or legitimate than physical illness, leading to reluctance on the part of policy makers and insurance companies to pay for treatment. Parents may be blamed for causing mental illness in their children. The public may shun people with mental illness and avoid living near them, working with them, and socializing with them.

Our current understanding of mental illness is that it is caused by a complex interaction of genetics and environment. Brain chemicals called neurotransmitters appear to be disordered in some mental illnesses. Research has shown that there is a hereditary component to many mental health disorders. Often, a genetic vulnerability interacts with certain stressors in a person's family life, social circle, or work situation to trigger an episode of mental illness.

Mental illness cannot always be clearly differentiated from normal behavior. Distinguishing normal bereavement from depression, for example, may be difficult in the face of a significant loss, such as the death of a spouse or child. Likewise, a diagnosis of anxiety disorder in relation to a person's worry and stress regarding his job is somewhat arbitrary, because most people experience these feelings at some time. The line between a person's having certain personality traits and having a personality disorder can be blurry. Mental illness and mental health, therefore, are best thought of as residing on a continuum.

Deinstitutionalization

A movement in recent decades to bring mentally ill people out of institutions has been made possible by the development of effective drugs, along with some change in attitude about the mentally ill. With the deinstitutionalization movement, greater emphasis has been placed on viewing mentally ill people as members of families and communities.

Research has demonstrated that certain interactions between families and patients can improve or worsen mental illness. Therefore, family therapy techniques have been developed that dramatically prevent the chronically mentally ill from needing to be reinstitutionalized. Today, the family of a mentally ill person is more involved than ever as an ally in treatment. The family doctor also plays an important role in rehabilitating a mentally ill person into the community. In addition, mentally ill people who must be hospitalized are less likely to be isolated and restrained than in the past, and they are often discharged early into day treatment centers. These settings are less expensive because fewer staff members are needed, the emphasis is on group therapy rather than individual therapy, and people sleep at home or in halfway houses.

However, the deinstitutionalization movement has had its share of problems. Because mentally ill people who are not a danger to themselves or society can no longer be institutionalized or treated against their will, many have become homeless. Although these legal measures protect people's civil rights, they make it more difficult to provide needed treatment to many mentally ill people, some of whom may be extremely irrational. Homelessness also has an effect on society.

Social Support

Everyone requires a social network to satisfy the human need to be cared for, accepted, and emotionally supported, particularly in times of stress. Research has demonstrated that strong social support may significantly improve recovery from both physical and mental illnesses. Changes in society have diminished the traditional support once offered by neighbors and families. As an alternative, self-help groups and mutual aid groups have sprung up throughout the country.

Some self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous, focus on addictive behavior. Others act as advocates for certain segments of the population, such as the handicapped and older people. Still others, such as the National Alliance for the Mentally Ill, provide support for family members of people who have a severe mental illness.