The issue of mental illness was thrust into the national spotlight on Oct. 1, when a gunman killed nine people at a community college in Oregon, drawing worldwide media attention. Far less attention is paid to the millions of people in communities across the United States who experience mental illness and never resort to violence. However, it’s important that they get public attention and the attention of local health departments as well.
Mass shootings have shaped national debates about mental health and gun laws. According to the Mass Shooting Tracker, 297 mass shootings have occurred in the United States since the start of 2015. Mass shootings are defined as incidents where four or more people are killed or injured by gunfire. The National Association of County and City Health Officials (NACCHO) recognizes the burden and impact of firearm-related injury and death as a national public health issue. In 1999, NACCHO established a Prevention of Firearm-Related Injury and Death policy statement to address the ongoing issue, and updated the policy most recently in 2013. As NACCHO president, I urge public health professionals to improve access to quality mental health care that is culturally competent and accessible to geographically remote areas.
Public health has traditionally focused on issues related to physical health. But in more recent years, the field has recognized the need for mental health programs to combat untreated and undertreated mental illnesses.
October is National Depression and Mental Health Screening Month. Public health professionals are encouraged to increase awareness of depression and other mental illnesses, promote the importance of a mental health screening, and reduce the stigma associated with mental illness. Local health departments support mental health promotion efforts in a variety of ways by providing direct mental health services, connecting constituencies to mental health resources, and advocating for policies that prevent suicide.
The Prevalence of Mental Illness
According to a report by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) titled Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings, an estimated 43.8 million adults age 18 and older in the United States had a mental illness and 10 million had a serious mental illness in the previous year. Additionally, 2.6 million youths aged 12 to 17 (10.7%) experienced a major depressive episode in 2012. Mental illness takes a significant – and sometimes devastating – toll on both adults and youth. The National Alliance on Mental Illness (NAMI) reports that those with depression have higher rates of death, particularly due to suicide and substance abuse.
Two populations are particularly affected by mental illness: veterans and homeless people. The Department of Veterans Affairs estimates that 11 to 20% of returning service members have post-traumatic stress disorder, which is often accompanied by other mental disorders such as depression and anxiety. According to the National Coalition for the Homeless and SAMHSA, 20 to 25% of the homeless population has some form of mental illness. Homeless individuals seeking treatment often receive more fragmented mental health care and less support for long-term management of their mental illnesses.
Mental health and physical health are interrelated in substantial ways. According to NAMI, people who have suffered a stroke or who have heart disease, diabetes, cancer, Parkinson’s disease, or HIV/AIDS are at a much greater risk for depression than the overall population. There is also evidence that depression negatively affects the course of physical health.
The effects of mental health on the greater society are also considerable. NAMI estimates that depression alone costs workplaces an estimated $43 billion per year in direct and indirect costs. Untreated or undertreated mental illnesses also create sizeable costs for emergency rooms and correctional facilities.
A mental health screening allows practitioners to detect mental health conditions in the early stages of development, making treatment more effective. There is also a need for more affordable mental health services and greater awareness about existing mental health programs. In SAMHSA’s 2013 survey, 1.3 million adults with a serious mental illness had a perceived unmet need for mental health care and did not receive mental health services in the previous year. The top two reasons these people reported for not receiving mental health services were an inability to afford the cost of care (61%) and not knowing where to go for services (27%).
Local Health Department Innovation
A number of local health departments are addressing the mental health needs of their communities in innovative ways. In 2014, Hennepin County (MN) Human Services and Public Health won a NACCHO Model Practices Award for establishing a drop-in medication management clinic to reach clients of its behavioral health clinic with high no-show rates, poor engagement in care, and complex treatment needs.
The drop-in clinic provides assessment of needs, evaluation and treatment, medication management, prescription services, and care coordination. It also makes referrals to numerous internal and external ancillary services. The clinic operates each Wednesday afternoon for approximately four hours and is staffed by two prescribers, two to three staff nurses, and a contracted pharmacist. A clinical supervisor and care coordinator also support the clinic.
The drop-in medication clinic reduced no-show rates and the number of clients lost to follow up, and increased clients’ participation in their treatment and recovery. The drop-in clinic also positively impacted service delivery for all clients because the health department has increased capacity to dedicate to scheduled visits.
The Marshall County (IL) Health Department won a NACCHO Model Practice Award in 2012 for establishing a Behavioral Health Task Force that was instrumental in obtaining funding and providing services in a medically underserved area. In 2007, no mental health service providers existed in the county.
In reaction to a substantial increase in suicides due to drug use among youth, domestic violence, untreated postpartum depression, and other factors, the health department conducted a comprehensive community needs assessment using NACCHO’s Mobilizing for Action through Planning and Partnerships framework focusing on mental health needs. Two key issues emerged from the assessment: a lack of available and accessible services and a negative stigma toward mental illness.
The results of this assessment led to the development of a Behavioral Health Task Force that has been instrumental in obtaining funding and service provision since October of 2010. The task force has published articles in the local newspaper about mental health on a regular basis, conducted mental health first-aid trainings with first responders, and obtained funds to increase mental health service delivery in the health department clinic from three days per week to five days per week. The task force also substantially increased awareness among community members about the mental health services available to them.
NACCHO encourages local health departments to commemorate National Depression and Mental Health Screening Month by raising awareness of mental health and encouraging their constituents to seek a mental health screening. The following resources provide more information for local health departments about mental health services and programs.
NACCHO Model Practices Award Winners
- Hennepin County Human Services and Public Health – Drop-In Medication Clinic
- Marshall County Health Department – Public Health Response to Access to Rural Mental Health Services
- Prevention of Firearm-Related Injury and Death Policy Statement
- NACCHO Suicide Prevention Policy Statement
- Preventing Suicide: A Toolkit for High Schools http://www.naccho.org/toolbox/tool.cfm?id=4459
- Community Action Guide: Supporting Families Impacted by Substance Abuse and Trauma
- Related NACCHO Voice Blog Post: Safe Storage of Firearms Prevents Suicide
- The Centers for Disease Control and Prevention – Mental Health Resources
- SAMHSA – Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings
- NAMI – The Impact and Cost of Depression
- National Institutes of Mental Health – Depression information https://www.nimh.nih.gov/health/topics/depression/index.shtml
- National Center for Post-Traumatic Stress Disorder
- American Psychological Association – Health and Homelessness Fact Sheet