“To improve the mental health of the nation we need better organisation not
Disorders of mental health and drug use affect individuals of all ages and demographics and are highly burdensome to society. At least 18.1% of American adolescents experience some type of mental illness, 8.4% have a drug use disorder, and about 3% experience mental health and substance use disorders co-occurring (SAMHSA, 2016). In the United States, health-related expenditure on mental health disorders was approximately $201 billion in 2013 (Roehrig, 2016). In addition, mental health circumstances are four of the top five sources of disability in individuals 18–44 years of age (WHO, 2001). While knowledge of recognition and treatment has progressed steadily, the effects of that knowledge on public health have lagged. There are now more efficient and specific treatments than in the past, and if handled correctly, an enhanced number of individuals with these circumstances can now lead a productive and helpful life.
Behavioral health is a key element of general health. People with chronic medical conditions in main care settings— such as diabetes, asthma, and cardiovascular disorders— have a greater likelihood of getting a drug use disorder or more prevalent mental health disorders, such as depression and anxiety disorders. Mental health or substance use disorders with overall medical circumstances, complicates both management and coexistence. People with more serious conditions of mental health — such as psychotic disorders, complicated bipolar disorders, treatment-resistant anxiety, serious obsessive-compulsive disorder, and drug use disorders — commonly have or develop medical issues such as diabetes or heart illness, and often die soon – as much as two decades sooner than the general population.
Although there is a fundamental link between behavioral health and overall health, disorders of general medical, mental health care and drug use schemes are split. The three care schemes function independently from each other for historical, cultural, economic and regulatory purposes. Individuals with co-occurring behavioral health and general health circumstances make up a large portion of the so-called super user group. Most of the enhanced costs for those with mental health and substance use illnesses are due to medical facilities, so there is potential for significant savings by integrating behavioral and medical services (Melek et al., 2018). In the areas of mental health and drug use, we have an “execution” issue and a “know-how” issue. Although there is still a need to develop better and more effective personalized treatments for many conditions, we do have effective treatments; but many of the people who can benefit from them have not been successful in getting these treatments. We are not routinely applying accountability strategies that offer incentives to use these models. Execution is ham¬pered by shortages and misdistribution of psychia¬trists, psychologists, social workers, counselors, and other providers that care for these populations. The stigma attached to these conditions, as is often per¬petuated in the mass media, still presents a challenge to getting people the care that they need. And we have substantial knowledge gaps. Currently, available treat¬ment approaches are not always effective, and many patients are not able to achieve optimal response. We need to develop more effective treatments and learn much more about tailoring treatments to individuals. We also need to develop better strategies for imple¬menting effective programs across large and diverse health systems.
Melek, P. S., Norris, D. T., Paulus, J., Mattews, K., Weaver, A., & Davenport, S. (2018). Potential economic impact of integrated medical-behavioral healthcare. Denver, CO: Milliman Inc.
Mental Health and Substance Use Disorders. (2019, 13). Retrieved from http://www.samhsa.gov/disorders
Roehrig, C. (2016). Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion. Health Affairs, 35(6), 1130-1135. doi:10.1377/hlthaff.2015.1659
World Health Organization. (2001). Chapter 2: Burden of Mental and Behavioural Disorders. In World Health Report 2001: Mental Health: New Understanding, New Hope – Overview. Geneva, Switzerland.