Yesterday I was writing about the lack of attention given to promoting mental health and wellness. There is a very large psychiatry enterprise consisting of psychiatrists and clinical psychologists, inpatient and outpatient treatment facilities, and of course, a huge segment of the pharmaceutical industry. About 24% of adults and 20% of youth have a diagnosable mental disorder during a one year period. Given that burden of mentall illness in society, it is striking that there is so little effort put into preventing mental illness and promoting mental health.
Traditional public health agencies rarely have any involvement with mental health. Even when they do community health assessments, the level of analysis is minimal. For example, the national Behavioral Risk Factor Surveillance System has a question on mental health: “For how many days during the past month was your mental health not good?” While this is a start, there is no effort to identify underlying factors. While there is a whole set of questions on diet and obesity, there is only this single question about mental health. Healthy People gives some attention to mental health, but there is not really much about primary prevention. The U.S. Centers for Disease Control barely touches on mental health, with the exception of suicide prevention.
Schools could have a role to play in helping kids establish good mental health, but their usual practice is to identify students with problems and refer them for assessment and counseling. Schools are very involved in drug abuse prevention, and some of the prevention curricula address emotional adjustment.
Taking a step back from schools brings us to families. Clearly the early influences of family life and the interaction of children with parents and other adults has a huge impact on their emotional development. Family research has learned a lot about how to raise happy and well adjusted children, and some of this information is directed toward parents by schools, mental health agencies, faith communities, pediatricians, and other public and private organizations with concern for children's welfare. Because of the nature of families and their place in a democratic society, concepts regarding children's mental health are only recommendations. Organizations inclined to offer parent education programs often have to fight the stigma that moms and dads attending such programs must not be very good parents.
Though good mental health among the population is in society's best interest, there are not many ways we can take public actions to assure or support it. Because depression is associated with poverty, society's efforts to provide income supplements, housing subsidies, and health care for disadvantaged persons are indirect but important measures to take in promoting mental health. In the most severe cases of child abuse and neglect, the government can step in to provide a child a more nurturing environment. Unfortunately, all of these measures are not fully effective. Trying to eliminate poverty is diabolically difficult, and many children endure degrees of family dysfunction that never reach the attention of appropriate officials.
Our society does take steps to help people cope with stress and anxiety. This comes in the form of media information, classes, a variety of products, such as herbs and massage devices. Currently we are fixated on "wisdom" from the orient (yoga, tai chi), as though Asians know more than others how to live stress-free lives. The stress remedies are like the variety of diets. They will probably all help someone reduce stress, but very few will lead to long term peace and serenity.
Another idea that is worth pursuing from a public perspective is resilience. Child development researchers have found that there is a subset of children who are survivors. In spite of growing up in a dysfunctional family, living in poverty, having only one parent, or parents with mental illness, or other kinds of disadvantages, they become happy, functional, successful adults. The key ingredient with resilient children may be having a prosocial relationship with another adult, such as a coach, a youth paster, or even a neighbor, to compensate for deficiencies in support and nurturing from one or both parents. Another resilience factor is bonding with the social values of school. Children who learn to value school and identify with the optimistic mission of educational opportunity and have good relationships with teachers are much more likely to be resilient in the face of other challenges at home and in the community. Schools, faith communities, and various other agencies can take steps to strengthen resilience among young people, laying the ground work for life long good mental health. This is application of the concept "It Takes a Village to Raise a Child."
Mental health promotion is way behind other types of health promotion. In the generations going forward, more time and energy must be invested if we want to see progress over the mental illness pandemic.
4 comments:
I appreciate the post on mental illness and how the issue is seemingly ignored by public health professionals. Since the beginning of grad school, my interest became focused on eating disorders, which have the highest mortality rate of any mental health illness. It seems like the work done with that population is largely through dieticians, psychologists, and other primary health professionals. My goal is to someday work within the prevention aspect of this mental health disorder that hurts so many and I hope that public health work expands to other mental health disorders as well.
Elizabeth, I think what it will take is people like you who have a vision for something that has never been done. You use a perfect example of the problem. Why doesn't public health embrace the problem of eating disorders, and give it the priority it deserves?
My 16 niece just died from bulimia. Her mother had sought treatment for her but after a certain age they said that my niece had to consent, but she wanted to "try it on her own for awhile."
On a separate thought, we spend so much time focused on obesity, we forget that starvation kills too, and that's something that supposedly doesn't happen in America, even with a medical diagnosis. I liken this to the mentality that surrounds moving from a birth control mindset (I could get pregnant with any act of sexual intercourse.) to the trying to conceive mindset (Why didn't I get pregnant my first month of trying?). So if you're not obese, you're healthy. Just as the range of natural fertility (not the case of infertility) has a range, so does healthy weight.
Since the beginning of grad school, my interest became focused on eating disorders, which have the highest mortality rate of any mental health illness. It seems like the work done with that population is largely through dieticians, psychologists, and other primary health professionals. My goal is to someday work within the prevention aspect of this mental health disorder that hurts so many and I hope that public health work expands to other mental health disorders as well.
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