Mental Health illness

Introduction
Mental illnesses denote the collective diagnosable mental problems and it is characterized
by abnormal sustained alterations in mood, thinking or behaviors that are related to the distress
of impaired functioning. Mental illness is a public health problem that is very important in its
right as well as because the condition’s association with different other chronic diseases as well
as the mortality and morbidity that results. World Health Organization (WHO) make arguments
that mental illnesses result in more disabilities in the developed countries than for any other
category of illnesses including heart diseases and cancers. According to research, one person in
every four experience mental illnesses while half would at least develop a mental illness in their
lifetime. Mood disorders and anxiety are the most common mental disorders experienced
globally. Mental disorders have various effects which range from minor disruptions in daily
activities to incapacitating social, personal and occupational impairments which can even lead to
premature deaths. Statistics indicate that mental disorders cost United States approximately $
300 billion annually, including about $ 193 billion that was from wages and lost earnings as well
as $ 24 billion that were of disability benefits. This article describes mental health care problem,
the countries that are affected, efforts that have been put up to address the problem, the key
players as well as the key policy issues. Later on in the second part, the article evaluates in the
details the mental illness problem in the United States.

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Mental Health illness

Mental health is a global health issue that has affected most nations. Mental health is
defined as the state of well-being, where every individual realize their own potential, they are
able to cope with their life stresses normally, they can work fruitfully and productively and are
able to contribute to their communities in a particular way. World Health Organization (WHO)
stresses on the positivity of mental health and in its constitution define health as the state of
complete physical, social and mental well-being. It is not merely the absence of infirmity or
diseases. Mental health is an important part in the health of an individual. An individual cannot
be health if they do not have mental health. IHME (2016) states that mental health is more just
an absence of mental illnesses. Biological, socioeconomic and environmental factors determine
mental health of an individual.
Behavioral and mental disorders are the disorders associated with mental health. Mental
disorders include the major depressions, anxiety, schizophrenia, dysthymia as well as bipolar
disorders. These are global, serious and common. Since mental health is important to human
condition, as recorded in history, behavioral and mental disorders have a life-altering and
profound impact on the experience of human beings. The health issue also has an enormous toll
of loss, suffering and disability on the suffering individuals. Mental disorders do not select
individuals on which to affect. Mental health illnesses ruthlessly afflict all people across
ethnicity, nationality, religion, age, gender, race and socioeconomic status (Nolte and McKee).
However, the weight of the issue on health care has not received the necessary attention
in the agendas of global health. Global health field engage practicing inattentional blindness as it
focuses on other different proprieties. The global burden on behavioral and mental disorders has
not been expressed well historically. This has caused an extension to the mental health issue to

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be neglected and ignored in the global health agenda especially in terms of research, practice
initiatives as well as policies that address the issue. Healthier 2020, depends on coming up with a
capacity as well as a workforce that would be prepared to address the mental health care
requirements for the purpose of a progressively ageing global population (Bates).

Countries Affected

Behavioral and mental health disorders is a global issue pressing the public health
priorities in most countries. The issue is similarly faced by majority of the countries irrespective
of their social, economic and cultural disparities and diversity and they therefore have a lot that
they need to learn from the experience that they share. Currently, mental disorders are
recognized as the leading reason of global disability. It is estimated that 22.2 percent of all the
years that were lived with the disability mental disorders were the main cause. According to
research, the disability that is associated with behavioral and mental illnesses exceeds problems
that are associated with the other diseases that are non- communicable such as diabetes, cancer,
HIV/AIDs, war and injuries, neurological as well as cardiovascular diseases. According to WHO
(2016), if unipolar depressive illnesses are left unabated, they would be the leading causes of
disease burdens globally by 2030 regardless of a country or its levels of income.
According to research, one person in every four in the world is affected by a neurological
or mental disorders at a certain time in their lives. There are different interventions that have
been put up on the treatment of mental disorders. The awareness of treatment needs for people
with this illness has go ne up but the number of individuals who require the treatment still
remains high in all the countries. The treatment gap is estimated to be 76- 85 percent for middle-
and low-income countries, and for the high- income countries it remains 35- 50 percent.
However, despite the need acknowledged, there has not been significant changes in the delivery

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of mental health care in the previous years. This is as a result of public health priorities, lack of
financial as well as human resources and the lack of legislation and health policy in different
countries. According to the estimates by WHO in 2011, there was a shortage of about 1.18
million mental health physicians who included 628,000 nurses and 55,000 psychiatrists in mental
health as well as 493,000 psychosocial care providers that were needed to treat mental disorders
in about 144 countries that are regarded as middle and low income. It was also estimated that an
annual wage bill that would be required to eliminate such a shortage was $ 4.4 billion
(Cunningham). Many countries are affected by mental illness. The rates of effect are as in the
figure.
The figure below shows the position of mental illnesses in comparison to other disorders across
different countries.

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Source: Institute of Health Metrics and Evaluation (IHME), 2012.

Efforts to Address Mental Health issue, Key policies and Stakeholders
‘Health does not exist without mental health’ was a slogan that was recognized on May
2013 when the 66 th World Health Assembly (WHA) adopted WHO’s Comprehensive Mental
Health Action Plan (CMHAP). CMHAP was adopted to ensure that the social and national
sectors employed an approach that was coordinated and comprehensive in order to reduce global
burden of behavioral and mental disorders. The imprimatur of World Health Organization has
the potential to bring about changes in the global mental health problem. The strategies that were
set up on healthier 2020 would prioritize policy, research and practice of mental health for the
achievement of a large success that would alleviate suffering and therefore restore the dignity for
the individuals that live with mental health disorder.

In the 1990s, Global Burden of Disease (GBD) study was initiated. It consisted of
about 500 researchers that collaborated scientifically with a common aim. The aim of the
researcher was the quantification of comparative magnitude of loss as a result of injury and
diseases globally. The scientific collaborators, GBD gathered data from all over the globe in the
years 1990, 2005 and 2011 and used the data to come up with a research study. The study has
generated about a billion health estimates about 187 nations. This has resulted to a watershed
event that brought the full relief of the public health problem of mental illnesses. GBD
established a metric burden referred to as “Disability- adjusted life year” (DALY) that was a
representation of years that an individual lives with a disability (YLD) as well as the years lost in
life (YLL). This establishment is important in the estimation of a health burden. According to the
metric that was established, one DALY is the same as the loss of one year of healthy life. Thus,

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the incorporation of disability in the analysis of DALY, it became possible to appropriately
determine the size of the hidden burden that is associated with behavioral and mental disorders.
The 66 th World Health Assembly adopted a comprehensive action plan 2013- 2020 on
mental health. It was said that the action plan was a landmark achievement whose main focus is
on the international attention on this problem that has been neglected for long even though it is
firmly rooted on human rights principles. The action plan’s main purpose was to call for changes
in the attitudes which perpetuate discrimination as well as stigma which has isolated individuals
ever since the ancient periods. The action plan also calls for services to be expanded so that
greater efficiency in the use of resources would be promoted.
According to WHO, the main goals of the 2013- 2020 Action Plan was to strengthen
governance and leadership that is effective for mental health, provision of responsive mental
health that is integrated and comprehensive as well as social care services that would be based in
community settings, implementation of strategies that would promote mental health and prevent
mental illnesses and to strengthen research, information systems and evidence for mental health.
Each of these objectives was to be supplemented specific targets that would provide a collective
action for the measurement and achievement of the global goals by the member states. Core
indicators that are related to the targets and the other actions were developed and they are still
being collected in the project named ‘Health Atlas’ on a periodic basis (“WHO | Comprehensive
Mental Health Action Plan 2013–2020″).

Mental Health Condition in the United States

Mental health problem in the United States has been an issue on the rise. The problem
affects millions of citizens in different ways and the degrees of severity they happen with vary

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from an individual to the next. In the United States, there are cases where patients have been
treated in great success, where the symptoms were completely eradicated. However, in some
patients, the symptoms were very debilitating such that the individuals were unable to
completely be healed because the symptoms never disappeared completely.
According to a report that was released in 2014 by Congressional Research Service
(CRS) on the prevalence of the problem in United States, after substance use disorders were
accounted for, 40.3 percent adolescents and 25 percent adults were reported to be suffering from
mental illnesses within a period of twelve months. In a different report, SAMHSA of 2014, adult
mental illnesses since 2011 to 2012 found out that about 42.5 million adults in the United States
suffered from mental illness. In addition, there were about 9.3 million individuals who suffered
from disorders that were severe in such a manner that their daily activities were impeded or
significantly impacted.
Large- scale surveys were conducted in the United States and were referred to as
Epidemiological Catchment Area (ECA) survey as well as the National Comorbidity Survey
(NCS). The NCS survey that was conducted between 2010 and 2013 showed that among the
disorder groups that were assessed, about 46.4 percent of the Americans were found to have
experienced either a mood disorder (20.8 %), DSM-4 anxiety disorder (28.8 %) or even the use
of substance disorder (14.6 %). According to the research, 50 % of all lifetime cases began when
they were at the age of 14 (Summergrad, 2014). The figure below shows the spread of mental
illness in the United States by States.

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Source: Summergrad, 2014

Primary Health Care Needs

Globally, health care in the United States is the most expensive. However, the outcomes
from health care are nothing that the country can brag about. For instance, Nolte and Mckee
argued that a study carried out in about 19 countries founds the U.S. to be at the top of the list
where deaths due to health care occurred. There are very low ratings for countries that focus on
lower cost and better health such as the United States. Evidence about the United States indicate
that having a large number of primary care professionals is related to lower rates of mortality.
Primary care is regarded to as the daily health care that is offered by health care
providers. It acts as the initial contact as well as the principal point in the continuation of care for
patients within health care systems. In the united states, a report released in 2009 indicated that a
high demand of health care by the ailing patients and the old people lead to a decreased number
of primary care professionals thereby resulting to a crisis in the delivery of primary care. There

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were a set of innovations that can enhance the efficiency, quality as well as the effectiveness in
primary care within the country (Bates).
The patient Protection and Affordable act (ACA) that was signed by president Obama in
2010 aimed for an expansion of health insurance coverage of 32million individuals by 2016 and
34 million by 2021. However, according to researchers, the success of the expansion largely
depends on the adequate availability of physicians for primary care. The project has already
showed that there is a deficit of primary care physicians required for ensuring that the care for
the Americans that were insured was according to the AAMC (Association of American Medical
Colleges). The shortage was estimated to be of 64,000 physicians by 2020 in the United States
without ACA. However, the implementation of ACA the shortage was predicted to rise to 91,000
physicians (Bates).
By 2010, it is estimated that 79.4 physicians were providing care to 100,000 residents.
Primary health care leads to better health care outcomes, lower spending and reduced health
disparities which includes hospital care and emergency room visits. However, primary care
suffers mainly because of the differences in its salary in comparison to doctors that decide to
specialize.

Key Indicators in Health Care Status and quality

Currently, there are about twelve indicators that cover the four main areas of treatment
that include continuity of care, care coordination and the outcomes of the patients. In the
continuity of care area, the indicators include the timely ambulatory follow-ups that are done
after the hospitalization of a mental health, continuity visits that take place once hospitalization
of dual psychiatric or conditions related to substances. Another indicator in this area includes the

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disparities of race or ethnicity in the follow-up rates of mental health. Continuity visits also take
place after the hospitalization of individuals with mental health illnesses. Coordination of care is
the second area that contains a single indicator, that is, the case management on psychiatric
disorders that are deemed severe.
There exists several indicators in the area of treatment. They include the visits conducted
during the depression treatment of the acute phase, the readmissions of patients with mental
disorders in the hospital, treatment durations for disorders that are related to health, the use of
anti- depressant and anti-cholinergic drugs among the elderly patients, the continuous medication
treatment that uses anti-depressant medications in the acute phase and finally, the indicator on
continuous medication treatment that uses anti-depressant medications in the continuation phase.
The last area of patient outcomes has a single indicator which includes mortality of the
individuals with serious psychiatric disorders (McLoughlin).
The Panel on mental health that saw the indicators being successfully passed believed
that the twelve indicators addressed the processes that were clinically important in treatment
areas as well as in the continuity and coordination areas. Each of the indicators has its distinct
importance. For instance, in the first area of timely follow- up after hospitalization, the indicator
is important because most patients take their treatment in inpatient settings for psychiatric
disorders that require the ambulatory care to be followed up for the promotion of recovery and
prevention of relapse (McLoughlin).

Organization and Financing of Health Care System

In the United States, the cost of health care system is higher than in other countries
worldwide. The government pays for health care through programs such as Medicaid and

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Medicare, employees do it by private health insurance plans or own funds. In U.S. technology is
advanced and expensive. In 2010, health care costs approximated $2.6 trillion dollars. The
amount used on health care has increased over the years. For instance, in 1960s, health care
spending was about 6% of the GDP but in 2010, the amount had increased to 17.6%. It is
estimated that United States spends about $8233 for every citizen on health care (Trivedi).

Extent of the Mental Health Problem in United States

A summary report released previously by the U.S. Centers for Disease Control and
Prevention (CDC) indicated that about 25 % adults in U.S. were reported to have a mental
illness. The rates of lifetime prevalence on mental disorders were approximated to be 50 percent.
According to the National Alliance on Mental illness (NAMI), about 20 percent youths aged 13-
18 years suffer from severe mental illnesses every year. About 13 percent were between the ages
of 8-15.
Mental illness are composed of different condition that affect American Citizens
differently. 1.1 percent of American adults (2.4 million people) suffer from schizophrenia. About
2.6 percent adults (6.1 million people) experience bipolar disorder. Approximately 6.7 percent
(14.8 million) Americans suffer from depression. About 18.1 percent (42 million people) suffer
from anxiety disorders like obsessive-compulsive disorder (OCD), panic, posttraumatic disorder
(PTSD), phobias as well as the general anxiety disorder. Approximately 70 percent youths who
are in juvenile systems of justice experience at least one mental health illness and 20 percent of
them experience a mental disorder that is severe (Summergrad).
Severe mental disorders cost the US about $ 193.2 billion that is lost annually. Disorders
that result from moods like depression appear to be third most common condition that leads to

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hospitalization in the U.S. for the adults (44 year olds) and youths (18 years). People that live
with severe mental illnesses risk suffering from medical conditions that are chronic. Individuals
with serious mental illnesses die with an average of 25 years largely because of medical
conditions that are treatable. More than 50 percent of the students in the United states who had a
mental health issue at the age of 14 years or more and happened to be in special education ended
dropping out. Research has also indicated that suicide remains the tenth cause that leads to death
in the United States. It is common than homicide. In the U.S. however, suicide remains the third
main cause of death in the ages between 15 and 24 years. About 90 percent of individuals that
died by suicide, did so as a result of mental disorder (Unite for Sight).

Efforts to Address Mental Health Illness in the United States
Among the efforts of the United States in the addressing of mental health illness, the
Mental Health America was founded and it works to improve lives of the mentally ill
individuals. The organization carries out lobbying efforts and research in its efforts on the
condition. The mental health care system in the United States has been improved by several
initiatives of the U.S. government. For instance Harry Truman passed National Mental Health
Act in 1946 for the creation of a National institute of Mental health and the allocation of funds in
researching the causes of as well as the treatment of the mental illness. Again, in 1963, the
Mental Retardation Facilities and Community Health Centers Construction Act was passed by
the congress to provide funding of mental health services that are community- based. Later in
1979, National Alliance for the Mentally Ill was founded for the provision of education, research
services, support and advocacy for the individuals with psychiatric illnesses. There are other
interventions and programs by the government of the U.S. which include social welfare
programs that worked in improving the access to mental health care (Unite for Sight).

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Conclusion
The knowledge of the number of individuals that are affected by mental health disorders
in a country and globally may be important in terms of helping the policy makers in
identification of particular problems and their scope. Mental illnesses are associated with a high
occurrence of diseases that are chronic such as diabetes, asthma, cancer, cardiovascular diseases,
obesity and epilepsy. The issue is also related to lower medical care usage, less adherence to the
treatment of therapies for chronic diseases as well as the risky health outcomes. There are very
many people suffering from more than a single mental disorder. About 45% of these individuals
with a mental disorder have been noticed to be suffering from more than two other disorders. In
the United States, mental disorders were found to be one among the five costly conditions in the
United States with expenditures approximating % 57.7 billion. It was found out that in every four
primary care patients, one of them was suffering from depression though primary care physicians
identified less than a third of all the patients. It is also evident that among 8.9 million adults who
have mental illnesses as well as substance disorders, 44% are able to acquire mental health
treatment. However, there are some mental disorders that are less likely to have a primary care
physician such disorders include bipolar and psychotic disorders.

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McLoughlin, V. “Selecting Indicators for Patient Safety at the Health System Level in OECD
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