Our Mental Health Crisis

Cynthia Koons has the story for Bloomberg Business Week. America is having a mental health crisis. If you think that we’ve never had it so good, it’s time for a rethink.  The economy is humming. Some cities are safer than ever. Life expectancy has increased. So, how does it happen that Americans are committing suicide at such high rates?

It’s well worth an article:

Unemployment is at the lowest level since 1969. Violent crime has fallen sharply since the 1990s—cities such as New York are safer than they’ve ever been. And Americans lived nine years longer, on average, in 2017 than they did in 1960. It would make sense that the psychic well-being of the nation would improve along with measures like that.

Yet something isn’t right. In 2017, 47,000 people died by suicide, and there were 1.4 million suicide attempts. U.S. suicide rates are at the highest level since World War II, said the U.S. Centers for Disease Control and Prevention on June 20, when it released a study on the problem. And it’s getting worse: The U.S. suicide rate increased on average by about 1% a year from 2000 through 2006 and by 2% a year from 2006 through 2016.

It’s not just the suicide statistics. Drug addiction is notably high, as is depression. 

Although suicide is the starkest indicator of mental distress, others abound. Drug overdoses claimed 70,000 lives in 2017, and 17.3 million, or 7%, of U.S. adults reported suffering at least one major depressive episode in the past year. Life expectancy, perhaps the broadest measure of a nation’s health, has fallen for three straight years, in part because of the rise in drug overdoses and suicides. That’s the first three-year drop since 1915 to 1918.

The problems may have different and varied causes, but what they add up to is a national mental health epidemic. The damage is on the scale of the global financial crisis, yet we lack the institutions, policies, and determination to address it. The government’s response has been inadequate, says Paul Gionfriddo, president of Mental Health America, an advocacy group. “The dollars have gone more to deep-end services in jails and prisons. It’s a really bad idea to put the money into jails because the people don’t belong there.”

Sorry to sound pedantic, but "mental health epidemic" is incorrect. One suspects that she wanted to say that we have a national mental illness epidemic. Don't they have editors at BBW?

What are we going to do our mental illness epidemic? Naturally, those who believe in such things want to throw money at the problem. Why not? What else is money for?

So, Koons suggests that things are not quite as rosy as they appear:

And the U.S. is home to some particularly challenging ones: stagnant wages; rising health-care costs; the proliferation of highly addictive opioids after a marketing push from major drug companies; the disappearance of well-paid blue-collar jobs and the emergence of the gig economy; the lack or limited availability of treatment and services. The destructive powers of technology, be it in the form of social isolation or cyberbullying, have been cited in the rising number of teens killing themselves. Suicide is the second-leading cause of death for 10- to 34-year-olds. Then there’s the prevalence of guns, which are used in half of all suicides.

By her reckoning, and by the reckoning of most policy makers technology has contributed to the problem, along with opioids and guns. Since technology produces social isolation,  it contributes to depression and suicide. This is not news. We ought all to know about it. We do not have such a good idea about how to solve it.

Among the other causes was the 1963 Community Mental Health Act. You see, under the influence of the anti-psychiatry movement, the government opened the doors of psychiatric hospitals. One notes, because so few people seem willing to do so, that the class of mental illness comprises a variety of conditions, conditions that appear to be similar but are not.

Psychiatrists today often consider schizophrenia and other psychotic disorders to be brain diseases. They consider bipolar disorder to be a metabolic condition. These are not in the same class as depression caused by social isolation.

Some federal actions have contributed to the crisis. Out of concern that patients were trapped in mental hospitals without a path out, President John F. Kennedy signed the Community Mental Health Act in 1963 to provide funding for new services in the community. The law “drastically altered the delivery of mental health services and inspired a new era of optimism in mental health care,” according to the National Council for Behavioral Health. It also came at a time when new psychiatric drugs were emerging, supporting the hope that the future was going to be brighter for people in need of care.

And yet, the hopes for a psychopharmaceutical fix have been dashed on the shoals of reality. The medications have surely been a boon to many patients, but that requires patients to take them. In many cases patients do not take them. If they are out on their own they are even less likely to follow prescription regimens. And also, civil libertarians have succeeded in making it nearly impossible to commit patients involuntarily, thus leaving dangerous psychotics free to walk the streets and to commit mayhem.

Koons continues:

Almost 60 years later, it’s clear things haven’t worked out that way. “People with severe mental illness can still be found in deplorable environments, medications have not successfully improved function in all patients even when they improve symptoms, and the institutional closings have deluged underfunded community services with new populations they were ill-equipped to handle,” Daniel Yohanna wrote in “Deinstitutionalization of People with Mental Illness: Causes and Consequences” in the AMA Journal of Ethics in 2013. That’s left people without the comprehensive care they would need to recover from drug addiction or suicidal thinking. Yohanna cites a poll of experts who say that 50 beds per 100,000 would meet Americans’ acute and long-term care needs. In some states the number is as low as 5 per 100,000. “I’d like to say things have improved a lot, but they haven’t,” he says today.

As we have often noted, the much-hyped anti-depressants have not lived up to the hope. This does not mean that they are useless. It means that they have not worked as well as touted:

The use of antidepressants in Australia, Canada, England, the U.S., and other wealthy countries didn’t lead to a decline in the prevalence and symptoms of mood disorders despite substantial increases in the use of the drugs from 1990 to 2015. The Lancet commission warns that mental health disorders could cost the global economy as much as $16 trillion from 2010 to 2030 if governments and businesses don’t do more to address them.

Naturally, Koons trots out Jacinda Ardern, prime minister of a nation of sheep, who has increased spending on mental health services. We note that New Zealand is a tiny nation, but a culturally homogeneous nation. We are happy to see that the prime minister of a nation of sheep has budgeted a few dollars for mental health services, but this assumes that the services are there, that they are administered competently and that they involve something other then medication.

Among the reasons for a mental illness epidemic is the simple fact that the services on offer, here especially, are mediocre at best. Many physicians offer medication because they have nothing else to offer.

Some countries have started to grapple with the problem. New Zealand Prime Minister Jacinda Ardern unveiled the world’s first Wellbeing Budget in May, earmarking NZ$1.9 billion ($1.2 billion) for mental health, which should also improve services for people living with the type of anxiety and depression that doesn’t require hospitalization but still has a major effect on their everyday life. 

While Koons thrills to the fact that Ardern banned guns, she does not know or refuses to report that nearly no New Zealanders have turned in their guns. The policy is obviously not working. It does not prevent those who want to blame it all on guns from persisting in misinformation:

Only weeks after more than 50 people were killed on March 15 in mosque shootings in Christchurch, Ardern demonstrated her willingness to tackle problems other governments have sidestepped by banning almost all military-style guns in the country. Shortly after the Virginia Beach shooting, President Donald Trump’s acting chief of staff, Mick Mulvaney, warned against wading into the politics of gun control “too soon.” U.S. lawmakers have failed to enact meaningful gun control measures despite an onslaught of mass shootings in the past five years.

And Koons concludes with a serving of liberal policy nostrums, offered by economist Joesph Stiglitz, a liberal economist who she does not identify as such:

These countries are saying that improving the physical well-being of their citizens isn’t enough. Seeing the limitations of traditional statistics, economist Joseph Stiglitz published “Beyond GDP” in the magazine Project Syndicate in December, a decade after Stiglitz co-authored the report “Mismeasuring Our Lives: Why GDP Doesn’t Add Up.”

“What we measure affects what we do, and if we measure the wrong thing, we will do the wrong thing,” Stiglitz wrote. “If we focus only on material well-being—on, say, the production of goods, rather than on health, education, and the environment—we become distorted in the same way that these measures are distorted; we become more materialistic.” Traditional numbers have failed us. It’s time for a new approach before America’s mental health deteriorates even further.

Yes, indeed, by this thinking we will improve mental health by fighting climate change… and by spending more money on education. Since much of American education is now an indoctrination mill, one wonders what advantage we will gain by having more of it.

Here’s something that has never crossed the minds of these great thinkers. The cure for depression is pride. In a nation where national pride is constantly trashed, where patriotism has become controversial, where white males are constantly implored to feel guilty for the horrors they have visited on the rest of the population,where everyone else is told to feel like a victim… why do you think that the nation should not be suffering a mental health crisis?