[andyt]

http://www.washingtonpost.com/wp-dyn/content/article/2005/06/06/AR2005060601651.html

Quote:

One-quarter of all Americans met the criteria for having a mental illness within the past year, and fully a quarter of those had a "serious" disorder that significantly disrupted their ability to function day to day, according to the largest and most detailed survey of the nation's mental health, published yesterday.

Although parallel studies in 27 other countries are not yet complete, the new numbers suggest that the United States is poised to rank No. 1 globally for mental illness, researchers said.

Add 287,000,000 guns to the mix, a high incidence of drug use, and kaboom

[RUEZ]

andyt wrote:

http://www.washingtonpost.com/wp-dyn/content/article/2005/06/06/AR2005060601651.html

Quote:

One-quarter of all Americans met the criteria for having a mental illness within the past year, and fully a quarter of those had a "serious" disorder that significantly disrupted their ability to function day to day, according to the largest and most detailed survey of the nation's mental health, published yesterday.

Although parallel studies in 27 other countries are not yet complete, the new numbers suggest that the United States is poised to rank No. 1 globally for mental illness, researchers said.

Add 287,000,000 guns to the mix, a high incidence of drug use, and kaboom

I think you have a valid point. The man that shot all those people in Arizona a week ago was clearly mentally ill, yet it was as easy for him to buy a weapon as it would be to buy a chocolate bar.

[andyt]

RUEZ wrote:

I think you have a valid point. The man that shot all those people in Arizona a week ago was clearly mentally ill, yet it was as easy for him to buy a weapon as it would be to buy a chocolate bar.

And he was stewing in an atmosphere that accepts and glorifies violence much more than other westerns democracies.

Apparently there have been 20 mass shootings a year on average in the last few decades in the US. Sorry can't remember where I read that, likely the latest issue of McLeans.

[sandorski]

I remember the Clinton Admin suggesting addressing this issue. Was shot down pretty quickly.

[RUEZ]

sandorski wrote:

I remember the Clinton Admin suggesting addressing this issue. Was shot down pretty quickly.

I like guns as much as the next guy, but I can't understand a society that would rather protect everyone's right to a firearm rather than protect everyone.

[Pseudonym]

Are the criteria for mental illness being consistently applied across nations? Overdiagnosis is one of the problems of the American healthcare system.

[andyt]

Pseudonym wrote:

Are the criteria for mental illness being consistently applied across nations? Overdiagnosis is one of the problems of the American healthcare system.

You'll have to ash WHO who did the study, or the Washington Post. I tried to find that WHO study, but gave up. Canada comes in at 20%, so we're not all that much better. But we don't marinate our people quite as much in a culture of violence, and we don't sell guns just next to the cereal aisle either.

[Scape]

They have a national sex offender registry in the US don't they? Why not a mental health one?

[Thanos]

Probably because no one really gives a damn about doing anything about it, especially if there's no potential for private-sector profit in the offering.

[kenmore]

Pseudonym wrote:

Are the criteria for mental illness being consistently applied across nations? Overdiagnosis is one of the problems of the American healthcare system.

What health care system.. The majority of US citizens don't have any.
A few years back the US was closing mental health hospitals and people who needed to be in them ended up homeless on the streets and living underground .
They started so called recovery models of care that failed. NYC is full of homeless schizophrenics who go untreated. The article is right on. The sad part is Canada follows the US and its model or lack of and we are going through the closing mental health Institutions now. There is a lot of talk but little walk in Mental Health reform and the situation will get worse over the next few years.

[Pseudonym]

andyt wrote:

Pseudonym wrote:

Are the criteria for mental illness being consistently applied across nations? Overdiagnosis is one of the problems of the American healthcare system.

You'll have to ash WHO who did the study, or the Washington Post. I tried to find that WHO study, but gave up. Canada comes in at 20%, so we're not all that much better. But we don't marinate our people quite as much in a culture of violence, and we don't sell guns just next to the cereal aisle either.

The study was funded by the National Institute of Mental Health, and the article refers to some "parallel studies" which are ongoing in other nations, but it doesn't really provide me with confidence that there are some objective set of criteria they will all be using.

[andyt]

Pseudonym wrote:

andyt wrote:

Pseudonym wrote:

Are the criteria for mental illness being consistently applied across nations? Overdiagnosis is one of the problems of the American healthcare system.

You'll have to ash WHO who did the study, or the Washington Post. I tried to find that WHO study, but gave up. Canada comes in at 20%, so we're not all that much better. But we don't marinate our people quite as much in a culture of violence, and we don't sell guns just next to the cereal aisle either.

The study was funded by the National Institute of Mental Health, and the article refers to some "parallel studies" which are ongoing in other nations, but it doesn't really provide me with confidence that there are some objective set of criteria they will all be using.

Ah - different study then, same result. I read about the 200(4? 6?) WHO study in an article about the Gifford shooting. I'm sure a diligent search would bring it up. And presumably they used the same criteria in each country.

BTW, Ukraine was second worst.

[Pseudonym]

kenmore wrote:

What health care system. The majority of US citizens don't have any.
A few years back the US was closing mental health hospitals and people who needed to be in them ended up homeless on the streets and living underground .
They started so called recovery models of care that failed. NYC is full of homeless schizophrenics who go untreated. The article is right on. The sad part is Canada follows the US and its model or lack of and we are going through the closing mental health Institutions now. There is a lot of talk but little walk in Mental Health reform and the situation will get worse over the next few years.

The majority of US citizens do have health insurance, and the system itself is open to all. I can acknowledge that there are flaws in the system without bemoaning faults that do not exist.
The current situation with the mentally ill is one of those flaws. We have gone from locking them up in institutions away from society to letting them loose without treatment. It is doubtful that we will find a happy medium to suit everyone's needs, but I'm open to suggestions.

[andyt]

We have the same problem as the US with de-institutionalization of the mentally ill. The idea to take them out of huge prison like places was a good one, but the idea to put them in smaller, more homelike settings was never done, 'cause it costs money.

BTW, abnormal psych taught me that the Quakers in the US were just as successful as modern psychiatry in treating mental illness. They did it by running farms where the mentally ill were housed, with a ratio of 1 caregiver to 4 patients. Now that we have drugs, mental hospitals might use 1 caregiver for 100 patients. A lot cheaper, but the patients have to deal with all the side effects of the drugs.

When I worked in the US, I had HMO coverage from my employer. I had to pay more per month than I do in BC for government health care, and my employer paid a lot more for me than I did. Yet I could not choose my physician, except one in contract with Kaiser, and to get treatment I had to be pre-approved by some uneducated numbnuts over the phone. Plus there would have been a co-pay. How many Americans actually have the full on Blue Cross type of insurance? And even there, you have to co-pay and can be refused for pre-existing conditions. Plus apparently sued to recover costs if they find any little thing you didn't tell them in the application form.

[Khar]

For the record, the US was found to have the highest rate. Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys. The study concept and design were designed by Dr. Kessler, the same one who authored the research quoted in the news article. This setup and the definitions used thereof are consistent amongst all sample groups, but as the article will mention there is a chance for bias (as with much statistical research of this kind, it also describes in the methodology how they attempted to reduce it's impact). It should be kept in mind that some forms of mental illness, as mentioned in the article and in the above link, were potentially excluded -- this includes some factors andyt is mentioning in his more recent posts, but does not exclude the entirety of all serious disorders which andy was discussing.

I seem to have access to a number of resources on this topic, including but not limited to the original NCS, NCS-R and NCS-A which have spawned a plethora of papers on the topic.

One such paper was called "Barriers to mental health treatment: results from the National Comorbidity Survey Replication" with the following abstract:

BACKGROUND: The aim was to examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the US general population. METHOD: Respondents in the National Comorbidity Survey Replication with common 12-month DSM-IV mood, anxiety, substance, impulse control and childhood disorders were asked about perceived need for treatment, structural barriers and attitudinal/evaluative barriers to initiation and continuation of treatment. RESULTS: Low perceived need was reported by 44.8% of respondents with a disorder who did not seek treatment. Desire to handle the problem on one's own was the most common reason among respondents with perceived need both for not seeking treatment (72.6%) and for dropping out of treatment (42.2%). Attitudinal/evaluative factors were much more important than structural barriers both to initiating (97.4% v. 22.2%) and to continuing (81.9% v. 31.8%) of treatment. Reasons for not seeking treatment varied with illness severity. Low perceived need was a more common reason for not seeking treatment among individuals with mild (57.0%) than moderate (39.3%) or severe (25.9%) disorders, whereas structural and attitudinal/evaluative barriers were more common among respondents with more severe conditions. CONCLUSIONS: Low perceived need and attitudinal/evaluative barriers are the major barriers to treatment seeking and staying in treatment among individuals with common mental disorders. Efforts to increase treatment seeking and reduce treatment drop-out need to take these barriers into consideration as well as to recognize that barriers differ as a function of sociodemographic and clinical characteristics.

The paper has not actually been published yet in paper form, I believe, as it is very new (literally put up at the end of 2010) but a PDF for download was available for folks with access to Scopus. The paper included the original article, and was a combined work from quite a few leading centers of learning. There are quite a few other articles out there on this topic, as well as a few others by the author.

I did manage to find an open source copy of NCS-R, or the replication paper for the original. Overall treatment patterns imply personal choice or knowledge on these illnesses poses the largest barrier to treatment rather than a lack of institutional availability. General trends suggest racial issues in acknowledging need for treatment, with some ethnic groups having worse rates for treatment, especially people of Latino or African descent in the States. Typically lower end disorders dominated the area not receiving treatment, especially such disorders as depression. Generally there is a positive relationship between severity of disorder and ability to seek treatment, but there is still a large disparity suggested in the results, as is mentioned in the news article, between those receiving treatment and those who need it.

I don't have a solid opinion at the moment, but I found most of this after about five minutes online so I figured I should at least provide an avenue for information, sources and literature on the topic which might otherwise be difficult to find. Do keep in mind that the original article is from 2005 so there has been a good deal of follow up literature on the topic and the WHO program did complete the aforementioned parallel studies. Their results are actually online for public viewing (so I'm not legally bound by terms of use regulations), but not an analysis from an expert or conclusions from them either, so I'm hesitant to link them.